This is a long story, but I'll try to keep it short. Five months ago, I had neck surgery for 3 degenerated discs in my neck. The surgeon took bone from my pelvis to insert between the discs in my neck. The day after surgery when I stood on my feet, I suffered a fractured pelvis - the bone broke off from where the donor bone had been taken. The next day, the surgeon operated again and tried to put the bone back in place with a plate and screws. A week later, the hardware came apart. After consulting with a pelvic specialist, I underwent a third surgery, where the bone was taken off completely and the ligaments involved were reattached. After much pain and much struggle, I am walking with a cane. However, I am now suffering with severe nerve pain in the knee to thigh area. The stinging severe pain with bouts of searing stabbing sharp pains are starting to get to me. I have undergone PT and I exercise daily at the gym. Of course the only way I can do this is because I am taking the pain medication Vicodin. I also have been diagnosed with stenosis and I have osteoarthritis. I have also suffered with muscle and joint pain for the last ten years. All I needed was damaged nerves in my leg to add to the misery. Can you tell me if this nerve pain will go away in time or should I see a neurologist. Thanks.

Answer :

My best advice to you is to see a neurologist because if the nerve pain is due to nerve damage (you have had many manipulations to that area), it is not likely to go away on its own.

Loss of sexual competency after pelvic surgery

I had a total hysterectomy a year ago. I am 45 years old. I was extremely sexual active, etc. Since the surgery, I seem to have lost desire and stimulation sexually. I am taking hormones and testosterone. No luck, No thrills, Nothing. I am wondering could I have experienced nerve damage during my surgery and this could be the reason why I feel dead everywhere. Can nerve conduction restore any damage in this area, the pelvic region...

Answer :

To answer the EMG question, Nerve conductions WILL NOT restore damaged nerve, they are purely diagnostic in nature and have no therapeutic effects. The other question is more the domain of ob/gyn specialists but certainly nerves can be damaged during surgery in this area causing symptoms similar to yours

Post laparoscopic hernia operation leg pain

I have had leg pain for 3.5 years. It started just after laparoscopic surgery for my hernia. The first 18 months left me crippled. The pain is less now but still persists in the hamstring area. I recently saw a local neurologist and he thought the leg pain and hernia surgery were unrelated and he did not think an EMG was appropriate (I disagreed). Question: In your travels, have you ever heard a story like mine, & what do you think? Thanks

Answer :

Pain after surgery could be due to injury during the surgery or to the position of the patient during the procedure. When the symptoms improve, it means that the nerve is slowly growing back. What patients may be left with is some unusual posturing which they used to put themselves in to relieve the pain but which is no longer needed. These types of postures respond very well to physical therapy.

Femoral Nerve entrapment

Would complex repetitive discharges at L3-L4 and a H-reflex latency of 32.4 msec on the right side be possible evidence or indication of femoral nerve entrapment, especially 5 months post op for femoral hernioplasty ?

Answer :

The involvement of L3-4 paraspinals and a prolonged tibial H-reflex provide no information about the integrity of the Femoral nerve. If you meant L3-4 Femoral muscle was involved (Quadriceps) and H reflex in the Quadriceps was that prolonged, then indeed Femoral neuropathy is present.

Post discotomy Lumbar Radiculopathy

I had a microdiscetomy on my lower lumbar L5-S1 and had a large portion of disc removed. I had 2 EMGs that were stated normal, and basically considered to be a malingerer since I couldn't activate my leg like they wanted me to, so anyways just recently I under went the 3rd this one was stated as a abnormal study, having electrical evidence of an old (healed ) or chronic right l5 radiculopathy, also stated needle exam reveals mild chronic reinnervation in a right l5 distribution, here's the question What does this mean in human terms

Answer :

In human terms, this is like having scar tissue on your nerve which can be detected by the needle inside the muscle. These findings are likely scar tissues from your previous surgeries, not evidence of a new nerve injury

EMG in Hamstring pain

The muscles (I think it's the muscles) in the back of my left leg from my gluteuss maximus to my ankle has been hurting since November. I've seen my doctor and she prescribed Motrin and heat. That didn't seem to work. I thought it was a strained/pulled muscle but I know by now it would've gotten better and it hasn't. My doctor thought that's what it was too. I went to an orthopedic and he examined me too. My appointment for an EMG test is tomorrow and I've wanted to know what they do? Does it hurt? What could it be? Please tell all.

Answer :

It sounds like your doctor is suspecting a pinched nerve and an EMG will be very useful in showing it or ruling it out. It is an uncomfortable test, where the doctor uses electrical shocks to study the nerves and needle probes to study the muscles, but does not last too long and is usually quite useful for conditions like yours.

EMG in lumbar disc prolapse

A friend of mine recently had and EMG with normal results. His MRI reveals herniated discs at L4-5 and L5-S1. He frequently has pain radiating into his legs. Is an EMG a reliable test? Are there ever false negatives? Any feedback would be greatly appreciated.

Answer :

Yes, EMGs can be "normal" in clinically and MRI confirmed root lesions. So if your friend has the clinical and MRI signs, a negative EMG does not rule it out.

Heel pain

I worked in the yard for a couple of hours on Monday morning. that afternoon it felt like there was a golf ball under my right heel when i walked. The next morning when I got out of bed my right heel hurt so bad I couldn't put the slightest weight on it. All day Wednesday and Thursday I couldn't walk because of the worst pain I have ever felt. (right heel) this is Friday morning and I am slightly recovering. Could this be a sciatic nerve thing? I have had this twice before in the last 40 years but it was both times in the knee. I am 69. any help would be welcome.

Answer :

What you describe does not sound like a sciatic nerve injury to me. My guess is that you have a local tendinitis, perhaps Achille's (heel) tendinitis which should improve on its own with some rest and icing of the heel.

Numbness in the legs

My mother is suffering from a numbness in her feet and legs that makes it almost impossible to walk It initially started as numbness in her feet several years ago. It has now advanced all the way to her thighs. The original diagnosis was Parkinson's - it's not. The Neurologist then suggested B-12 shots-it hasn't helped. She is now scheduled for an EMG next week. Any thoughts? Any past experiences?

Answer :

EMG stands for electromyography, which loosely translates into electrical testing of the muscles and nerves. The test is a little uncomfortable. The doctor uses electrical impulses applied to your skin to test nerve conductions and then uses a needle probe (without electricity) to study muscles in your leg and back. The whole test takes 30-45 minutes. The test is quite useful, although not a 100% fool proof, in detecting pinched nerves and diseased muscles.

Nerve damage healing process

Upon your advice, I went to see a neurologist and had an EMG. The doctor told me that I had nerve damage due to the three surgeries I had in October. He said that the nerves would eventually regenerate and gave me a prescription for amitriptaline. He wants me to work up to 50mg daily. Right now I am up to 40 mg. I notice a very slight improvement in the pain, burning, numbness, etc. Can you tell me how long the nerves could take to repair themselves? Am I looking at possibly a year or even more? It is the nerve that runs from the groin down both sides of the thigh and across the knee. Thanks for your comments.

Answer 1 :

Peripheral neuropathy (among other causes) commonly present with numbness in feet. Although we do not have all history and examination but as a first step in case of your mother is to rule out peripheral neuropathy by doing EMG and nerve conduction studies. I wonder do your mother have any symptoms in the hands? B12 deficiency is one cause of peripheral neuropathy.

Answer 2 :

The symptoms you describe are commonly seen with peripheral neuropathies, and when they go up to the thigh, it's a pretty advanced form. Neuropathies are most commonly seen with diabetes and alcohol (now or in the past) but there are a slew of other conditions, which can cause them such as (to cite only a few) toxic, occupational exposure, metabolic and nutritional problems, thyroid disease, a disease known as Guillain-Barre syndrome and of course B12 deficiency, which is accompanied by anemia. The EMG should help in finding out whether or not there is a neuropathy and what type, but does not tell you what's causing it. Based on the EMG results, a neurologist should be able to order some blood tests to determine (and see if it is possible to treat) the cause of the neuropathy.

Numbness along shin (anterior aspect of right leg)

2 months history of numbness along the shin complaint in a 55 yr. lady with no clinical evidence of peripheral neuropathy. No low backache, started insidiously.

Answer :

Numbness along the anterior aspect of the lower leg/dorsum of foot could be due to a superficial peroneal nerve lesion (check out the anatomy) or a root lesion or a mononeuropathy among others.. An EMG would be very helpful in this case

LL burning and weakness “p. neuropathy vs. myasthenia”

If a patient presented with leg burning, bilateral, and leg weakness, would not an EMG/nerve conduction study be one of the first tests a doctor might do? These were my symptons, and after two years, five neurologists, not one doctor did an EMG, until ten days ago. Diagnosis. Peripheral Neuropathy and possible Myathenis Gravis. From what I have read, it appears if the legs are burning, pain caused just by the touch of a hand, a sheet, or clothing, that an EMG should have been one of the first tests completed. What is your expert opinion? Thank you.

Answer :

Your symptoms are a definite indication for EMGs. The burning feet are due to what we call a small fiber neuropathy, usually seen in patients with Diabetes or nutritional disorders. Symptoms of Myasthenia include fatiguability, double vision, droopy eyelids etc. It is important to find out how sure is the Doctor who did the study on you of the Myasthenia diagnosis, or if he/she needs to refer you to a specialist in this disease, because if you have it, you need to be treated.

EMG / NCV in lumbar disc

I am scheduled for EMG/NC's next week. The latest MRI shows herniated disc at L5S1 and bulging disc at L4, with no significant changes from original one 2-1.2 years ago. 'Have had pain in back and legs for what seems like forever, now weakness is developing in left leg. What do these tests entail and do they hurt? Thanks for your help.

Answer :

EMG stands for electromyography, which loosely translates into electrical testing of the muscles and nerves. The test is a little uncomfortable. The doctor uses electrical impulses applied to your skin to test nerve conductions and then uses a needle probe (without electricity) to study muscles in your leg and back. The whole test takes 30-45 minutes. The test is quite useful, although not a 100% fool proof, in detecting pinched nerves and diseased muscles.

Nerve damage healing process

Upon your advice, I went to see a neurologist and had an EMG. The doctor told me that I had nerve damage due to the three surgeries I had in October. He said that the nerves would eventually regenerate and gave me a prescription for amitriptaline. He wants me to work up to 50mg daily. Right now I am up to 40 mg. I notice a very slight improvement in the pain, burning, numbness, etc. Can you tell me how long the nerves could take to repair themselves? Am I looking at possibly a year or even more? It is the nerve that runs from the groin down both sides of the thigh and across the knee. Thanks for your comments.

Answer :

Nerves grow very slowly, about 1mm/day, you can almost compare it to how fast a hair grows and you will have a ballpark figure. So it takes usually anywhere from 6 to 18 months. Amitryptilline and other drugs like it help relieve nerve pain such as yours so this should help and you should start noticing some improvements.

Intense thigh pain

About 3 weeks ago I woke up with a sore and stiff knee. 2 days later it went to what seemed to be my hip. I went to the doctor and was put on Vioxx and Ultram, X-rays were normal. I then went to a rheumatologist who said she thought the pain to be coming from my adductor muscle. I have intense pain especially at night, a limp, and muscle weakness upon lifting my leg, or walking. This came on suddenly and without any injury. Please any comments or thought on the cause would be greatly appreciated. This has been going on now for three weeks. I am beginning to get so down from this not to mention extremely fatigued from the lack of sleep. Please help!!!

Answer :

I am not quite sure from your description if you're having joint or neurological symptoms. Certainly a pinched nerve in your back could cause the thigh pain and weakness. Also there is a nerve called the femoral nerve which could be compressed in the groin in patients with diabetes (the condition is called diabetic amyotrophy) and cause these symptoms as well. If your pain and weakness are not improving, you should see a Neurologist.

Comment :

I have now gone to see a physical therapist, who, it seems has done more for me than any Dr. so far. She seems to think, after a half an hour of counsel with me and working on me, that my pelvis is of balance or out of line. This in turn is affecting the capsule around the hip joint, which is then affecting the muscles in the thigh and groin. She also said that the muscles in both of my legs were very tight. I must say, when I got of her table I thought I was cured for about a half an hour. I was able to go up stairs and walk without any pain. It was all back again that night. What are your thoughts on diagnoses like this. Is this very common? Have you ever heard of a case like this? Or any symptoms like this? Thanks!

Answer :

Again my concern in your case is the weakness you mention. A nerve lesion could cause the pain and the weakness whereas a pelvis lesion would cause mostly the pain. So unless you are sure that there is no nerve lesion or pinched nerve, you can treat it with Physical Therapy. But if the nerve is involved you'd have to do something about it otherwise no amount of physical therapy is going to cure your symptoms.

EMG for CTS & Spinal Stenosis vs. Hip Replacement

My mother broke her hip and her wrist in 1993. She has since been diagnosed with CTS and Spinal Stenosis. She is in quite a bit of pain and has just been referred for an EMG for the arm and the leg. Is there any reason that both could not be done on the same day? Also, will the EMG help to resolve the question of whether the stenosis or the hip is causing her pain?

Answer :

Usually the EMG of the arm and leg are done in a single session. Also the EMG will be able to determine whether or not the spinal stenosis is causing nerve damage which in turn causes pain.

Leg Crossing leading to foot drop

My teenage daughter recently had to observe her dance classes for 4 weeks instead of participating because of a healing stress fracture and while doing so continually crossed her bony long legs resulting in a peroneal injury affecting her toes and top arch. We had noticed a foot drop but thought it was related to adjusting to walking in an air cast for the opposite leg stress fracture. After noticing drop (into third week) of repetitive leg crossing, we backtraced the cause of the peroneal pressing and she is on the road of recovery. She went from a grade 0 of extreme weakness with no strength to a grade 3 - 3 1/2 of being able to lift her foot and flex toe in about three days of corrective behavior. Can we continue to see immediate and fast recovery as we have seen or will the recovery slow as the complete heal is in sight? Do you have any insight as to what we should do to help her recovery along? Her stress fracture on her opposite leg is healed after the six-week rest and she hoped to get back to dancing this week. Should she dance while holding onto the dance bare or would you recommend a complete recovery of the peroneal nerve before returning to dance. By the way, she is able of get on toe point and has not loss any leg muscle strength. We consider ourselves very lucky to notice this and stop the leg-crossing activity, although not quite soon enough.

Answer :

Thank you for a great description. Most likely, as you have figured out, this was due to her leg crossing behavior, specially if she doesn't have much fat padding which makes the nerve especially vulnerable to leg crossing. The rule of thumb is that if recovery begins early and fast, it will continue to do so because it is likely the lesion just involved the nerve sheath (the myelin) not the fibers the themselves (the axons) and the nerve will return to full function. I would be more careful on her returning to the dance floor however for the following reasons. She has a (freshly healed) fracture on the other side and she is not back 100% on the peroneal nerve lesion side, so you don't want her to fall at this point. I, personally, would wait until she got back 100% of her peroneal nerve function back before returning to the dance floor.

Abnormal foot movements after EMG & NCV; is it due to the test?

I had an EMG and nerve conduction test done for ALS because of some minor fasciculations The EMG found fasciculations, no fibrillations, so the neuro felt I was clean. But just 4 days after the test my foot, where most of the testing was done on, (at least five separate sets) started vibrating and fasciculating like crazy. It then spread after a month to my other foot. Is this not an uncommon reaction to the test? Thank you

Answer :

This is not a common reaction to the test; in fact I have never seen it happen. I cannot tell you what this is due to but if you feel that this is way out of the ordinary for you (and it has lasted this long) I would get in touch with your doctor and tell him/her about it.

Babinski sign

I have a question, which I can't find an answer in none of the medical books. A negative Babinski is when your toes crawl downward. A positive one is when your toes crawl upward What is the meaning of no movement at all?? Does it completely o.k. (Like crawling downward!) THANKS IN ADVANCE

Answer :

TNeurologists always have wild discussion on the misnaming of the "extensor" sign. (Flexion shortens a limb; extension lengthens it). It is therefore more appropriate to note that the toe goes up or down, instead of using the word "flexion" or "extension" alone. A "plantar flexion" and "dorsiflexion" are equally clear. But the key muscle is the extensor hallucis longus. Babinski--a French neurologist of Polish descent and a pupil of Charcot--was the first to differentiate between a normal and pathologic response of the toes and recognize its clinical implication. To answer your question, in a mute response, check that no paresis or weakness in effector muscles (e.g. peroneal nerve palsy, severe radiculopathy or peripheral neuropathy). Make sure that the foot is not cold.

I hope you will find a lot of information in this book:
The Babinski Sign: A Centenary

Numbness after a myeloscopy

After a lamenectomy in 1992, I began having severe pain in my left leg. I started getting steroid injections, which lasted only a short time. Was told I had a lot of scar tissue pressing against my nerve and a myeloscopy would remove some of the scar tissue. After having this done, I woke up having decreased feeling in my left leg and mostly my foot. It has s been 15 months and there is no change. I limp and have limited flexion in my ankle. I've been through therapy and it hasn't helped. Doctor is not mentioning an EMG, could I request this or even demand that I want it done? This is compensation and I have been back to work but it is very difficult to function.

Answer :

EMG should be helpful in your case to confirm the lesion and how severe particularly because you have numbness and limited flexion of the ankle, suggesting muscle weakness. At this stage (15 months passed from second procedure), if EMG changes seen could be related to lesion 15 months ago or from the older lesion of 1992.

Effect of hand Squeezing on LL NCV

When Having my conduction velocities study, It seemed that the neuro could not get what he wanted when giving me the electric stimulation to my legs (peroneal, tibial nerves), he then told me to squeeze tightly my hand and only then did he got what he wanted to get and said all was fine. Dear doctors! What do you think he could not get (I think I recall he said It was the Amplitude)? Was it "legal" - I mean I am just curious whether getting "the wanted NCV result" that way is all right and not "cheating"? THANK YOU FOR READING THIS AND RESPONDING!

Answer 1 :

That's is usually to get the F-wave in the lower extremity, and it is a "legal" maneuver.

Answer 2 :

Squeezing the hand during EMG helps to get better amplitude fro the evoked response: F-wave, H-reflex or a motor evoked response. Squeezing the hand is also asked to at times, by physicians during a clinical examination to obtain better deep tendon reflexes.

Hand contraction with EMG of LL

In read in previous post that it is quite common to ask the patient squeeze his hand in an EMG. A month ago I had my EMG and the neuro said he was not getting good CAMP amplitude as He had wished to, so told me to squeeze my hand. He also "hit" me with tremendous currents, and then he got normal CMAP. (Also read posts in this forum about it) About the nature of CMAP amplitude - A. How far can it change with higher currents, can it get from 2 to 15 MV (in supramaximal stimulation+25%)? in MU - How much can it change in low and high currents? B. In which current does he have to stop? Is there a "limit current" in which more current would not produce higher amp or "the sky is the limit"? C. And about the "squeezing the hand" thing - IN MV- HOW higher can it get? I mean, how much additional MU can squeezing the hand yield? (2,5,10,15)? And MOST importantly for me why some people get the right CMAP amplitude without squeezing the hand while others should do so - Does it depend on the physical condition of one's nerves or not - I mean if he asked me to do so - Is there a problem (even minor) with my nerves? Hope to get your insights on these "CMAP THINGS"

Answer :

As pointed out in previous posts that squeezing increases the motor response, it works by enhancing the response. Of course it will work to certain limits. To answer your point, it may increase from 2 mV to 15 mV. Once the maximum level or value is reached, then any further increase of current will lead to stimulation of the nearby nerves giving a false result. Therefore, only a 25% increase of stimulus is added after obtaining the maximal CMAP response to avoid such stimulation of other nearby nerves. All commercial EMG machines have limit of stimulation, which cannot be exceeded for patient safety. This squeezing method does not reflect any pathology of the nerves but just a physiological variation between individuals.

Comment :

What do you mean by maximal response? How can the examiner know when is the maximal response for a certain nerve? Because as you said, the higher current you give the higher amplitude you get! So how Does the examiner know when he had reached the point where he gets false increase from nearby nerves? How does he know what is the real "maximal CMAP response for a nerve”?? (And that from now on he crosses the limit of stimulating neraby nerves)
* What would be the range of normal CMAP for the peroneal? , Tibial? And ulnar?

Answer :

The following should help to get the best response. First of all the examiner should be familiar with the anatomy of the peripheral nerves. A surface electrode is used for stimulation; it is easier and less uncomfortable for the patient. The cathode of the stimulating electrode should be placed over the nerve closet to the recording electrode. The anode is placed parallel to the nerve, away from recording electrode, you may rotate it to minimize stimulus artifact. The nerve should be stimulated with stepwise increasing strengths. Enough current must be applied to activate all of the axons of the nerve. This amount, called supramaximal response can be obtained with an electrical stimulation of 10-75 mA and pulse duration of 0.1-0.5 ms. Over stimulation would produce latency artifactually short or a conduction velocity too fast for that nerve. Also, stimulation of adjacent nerves could produce CMAP larger than expected and has initial positive deflection (except tibial nerve). That how I would make sure it is a response from that particular nerve and no contribution from other nerves. This problem is encountered commonly between unlar and median nerves at thr wrist. Normal values from Liverson and Ma 1992: ulnar CMAP between 4-22 mV. Tibial CMAP 5.8-32 mV. Peroneal CMAP 2.6-20 mV.

Nerve damage and treatment for severe pain in LL

Had ACL reconstructive surgery 7 months ago and about 5 months ago I started having severe burning pain in my thigh. Like someone holding a branding iron to it. The pain is from my hip to my knee in varied spots. My neurologist has done many tests and his conclusion is that I probably injured it in PT. The nerve either got compressed or stretched. Is this something that goes away on it's own. He has suggested that I take steroids. Should I stay off of my legs? Because walking really irritates it. What are some other things I could do to help this heal? Thank you I'm so desperate

Answer :

In your case seems to be compression of the lateral femoral cutaneous nerve (meralgia paresthetica). But please tell me what is ACL stand for?. If it is meralgia paresthetica, then usually the symptoms would ease with the time which is variable between one patient and another. About the steroids, it is actually up to your treating doctor to decide the best treatment for you. Nerve conduction studies may help to diagnose although technically may be difficult and EMG needle examination may be done to rule out other causes. However, it is primarily a clinical diagnosis.

Comment :

Thanks so much for your reply. ACL is one of the ligaments in the knee. I tore it in an injury and bruised my shinbone. So I had surgery to replace the ligament on 10/18/99 and the pain in my thigh started around mid Dec. For nerve damage is it usually recommended to stay off your feet? Cause it seems to hurt so much more after walking etc. If not, should I use it as normal and exercise as well? Is icing recommended for nerve damage? Thanks again for your comments.

Answer :

Thank you Laura, gradual building up of excerice is good idea, but of course this depends much on your knee. I would also recommend the cooling therapy. All the best.

Can exercise delay or will it help to nerve healing after damage?

I am so confused about what to do to help with the healing process of a compressed or stretched nerve in my thigh. It hurts so much after walking. The pain has neither gotten worse nor better in 7 months. But it does subside if I don't use my leg at all. As soon as I go back to regular activity the pain starts. My question is this: Can exercise prolong the healing or will it help to heal it. So should I grin and bear the pain and eventually it will go away or should I stay off my leg. Am I damaging it more by exercising? My thigh muscle is just about gone at this point form atrophy. Help!!

Answer :

I think physiotherapy would help but it should be under care of physiotherapist. Taking advice from Pain clinic is another option.

Is it neuropathy or not?

In letters to my G.P. my neurologist has noted that I have "decreased pin sensation, temperature distally in the lower extremities. Position sense and vibration sense are normal. Deep tendon reflexes are absent in the lower extremities and +1 in the upper extremities..Babinski's sign is absent." He recommended EMG/NCS. After testing, he reported ". Normal sensory nerve conduction in the left superficial peroneal nerve with distal latency of 3.68mS..motor nerve conduction in the right peroneal nerve is within normal limits with a velocity of 40 meters per second and distal latency of 6.40 mS and left peroneal nerve with a velocity of 44 meters per second and distal latency of 5.20 mS. The H-reflex in the right and left tibial nerves is abnormal in that there are no responses. He concluded ". Not enough findings to really indicate definite neuropathy since the sensory and motor nerve conduction are normal." Entering the left superficial peroneal nerve distal latency of 3.68mS and the appropriate age, sex, and height (41, M, 190cm) into the appropriate boxes on your lower extremity sensory/H-Ref teleEMG calculator (thank you very much) produced an MRV of -4.2. I wasn't sure how to use the lower extremity motor calculator, but it may have produced negative MRVs of -1.1 or closer to zero. Three questions: 1) Neuropathy or not? , and 2) Can you recommend an unrelated source for normal values of EMG/NCS (I'm looking for corroboration) including books, and 3) recommend additional means of investigation and/or wait for progression. Based solely on reported findings (no foot problems, though arches somewhat high, thanks for asking), and slow progression over perhaps eight years or longer (just detected this, though deep tendon reflexes gone for at least six years), I am inclined to suspect some sort of very mild hereditary sensory neuropathy? Please reply. Thank You.

Answer :

Looking at your history and NCS data; you have some symptoms and signs to suggest neuropathy, and some data in NCS to support that (absent H reflex, right peroneal latency of 6.4 ms and CV of 40 m/s). Absent H reflex is definite abnormality (neuropathy is one cause but not the only one), and peroneal nerve, to me, it is slightly slow but it varies according to laboratory normal limits, but anyhow, not enough by itself to say peripheral neuropathy even if abnormal. However, additional information would be useful and important for instance, sural nerve, amplitudes of motor and sensory responses, F wave and needle EMG examination and perhaps additional test for small fibers (sympathetic skin response). Looking at the duration of symptoms seems to be very slowly progressive if any. I think a follow up study is worthwhile after several months. About the last point being hereditary or not, I would say, this study cannot tell you that, you need more information in the history and further genetic study that could be discussed with your neurologist. I hope this is helpful.

Comment :

Isn't a conduction velocity of 40 completely normal for the preoneal nerve?
If not what are the limits for this nerve in your laboratory?

I recovered from Sciatica about 6 weeks ago, thanks to a series of acupunture treatments (Which I highly recommend to anyone with this problem). I was told this could be due to problems with one of the discs slipping slightly in my lower back and resting on the Sciatic Nerve. I now have pain in the front of the same leg due to I think Femoral Nerve Problems. Are both these afflictions related? Could it be the same disc slipping in another direction? I am currently taking anti-inflammatories and will be attending the acupuncturist again, but I would like to know what preventative therapy I can do in order to not have either problem recur?

Answer :

Sciatica is common problem, derived from sciatic nerve as the name implied, but actually it is not compression on sciatic nerve but due to slipped disc at lumbosacral level. Other synonyms are radiculopathy, prolapsed intervertebral disc. According to your description, your symptoms are closely related but due to adjacent slipped discs. However, I assumed that your pain in the front of "leg" is related to the slipped disc and not due to femoral nerve because the later one would have the pain in the front of the "thigh" and not the leg. Clinical examination and EMG will be very helpful in your case. General measures to avoid or prevent disc problems are rest, give up smoking (to reduce coughing), avoid constipation, avoid lifting heavy objects, to pick up something kneel rather than bending your back, etc. Other instructions and exercises could be obtained usually from physiotherapist.

Goosebumps on thigh

For the last three months or so, my husband and a friend of mine have been experiencing goosebumps on their right thighs. No pain involved, but it happens whether they are sitting or standing. Both are pretty muscular.

Answer :

As there is no pain (or other symptoms), these Goosebumps seems to be?” Fasciculation=twitching" confined and repeated at single same place, this is benign, and physiological or could be related to exercise. If they are widespread, then you may seek neurologist advice.

EMG Test after injury to Cauda Equina

I had a laminectomy 8 months ago to relieve compression of my L5/S1 nerve root and L4/5 large herniation. I have bladder, bowel, sexual dysfunction and numbness in both my saddle area and left foot. What can EMG tell me about my prognosis?

Answer :

EMG can be used to assess the extent and severity of the lesion, these are important in determination of prognosis. Also, it could detect the signs of nerve regeneration. Thus, it can predict functional recovery.

Comment :

Thank you for helping me understand what my symptoms mean. I had a EMG/NCS (Needle)(Nerve Conduction Study) last week, and I did go see a surgeon, and they want me to have surgery again, but I am hesitant. I went through a lot back in 1994, and had to give up a good job because of all this. I worked in a factory as a machine packer, packing 300 sweet-tarts per minute, and picking up / gripping (using my index finger and thumb) each box putting them on the conveyer belt. I developed DeQuervain's syndrome, CTS, and a massive ganglion cyst due to this repetitive work. My doctor diagnosed me with repetition motion syndrome. I stayed off work for 6 years due to this injury.

I figured I would try and find a job this past year, and work part time. I wanted to gradually get back to work, and get use to using my hands again. The job I took was just part time 4 hours a day doing light data entry. That is when I started noticing my right hand having really painful muscle fasciculations in my thumb pad. At times, my right hand and fingers started having really painful charlie horse symptoms - cramps - sudden tightening of the muscle involuntary twisting movements, and uncontrollable hand motions. One other thing that started was my hand would get so cold, and lose all of it's feeling, where I couldn't even feel my hand. Like it was dead. The rest of my arm past my wrist was normal temperature. This has been getting progressively worse over the past year. You can feel my left hand and it is normal temperature warm, and my right hand is ice cold. I also find it very hard to write, and after holding a pencil or pen for very long, my hand starts having painful cramps and gets ice cold and becomes lifeless. I find it challenging to drive a car, open doors, pick up my grand daughter and a lot other daily activities are almost impossible.

May be all these new problems are because I've tried to go back to work, and my hand isn't use do this type of use. My concerns are: do I keep trying to work? I don't want sound over concerned about all this but my doctor back in 1994 told me he thought I might have waited too long in seeking advice and it may have caused permanent damage. After the testing last week my doctor said my muscles at the base of the thumb are starting atrophy and some of my sensation is permanently lost. All this is so discouraging and frustrating! Why is this happening? Am I going to loose total use of my right hand? Why do more problems keep arising?

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Answer :

As you said, you have long standing problem causing your symptoms. However, the idea of the surgery in your case to salvage as much as possible what is remaining of the median nerve. The surgery should also stop the pain. But the return of sensation after surgery takes quite long time to recover, if any, all depends on the degree of damage prior to surgery. That is, I believe, why your doctor is after doing the surgery for CTS again. You may go to work but in very gradual fashion afterwards.

Fever and Jaundice followed by abnormal gait

My son is a 13-year-old Pakistani boy- 4 years ago he had 2 episodes of prolonged fever and 1 attack of Jaundice and 1 attack of Measles in 3-4 consecutive months.... Since then he has developed a gait - he puts all his weight on the toes and his feet are flat- he walks abnormal dragging his feet and legs stiffened... Please if you could do anything to help my son - I'd be grateful - if You would like to have a chat with me on the internet about his reports - u could write me back the time and date - or if u want to view some of his reports of his tests in India - I could mail them too- whatever it is - I need your help, support and guidance - Please!!

Answer :

I read your note and I am not sure I would be able to help but I can give you some ideas. The symptoms you describe in your son's gait seem to originate from the spinal cord. In some of the infections you describe, involvement of the nervous system, particularly of the spinal cord may occur. Some of these diseases may be treatable by antibiotic and some may not. My advice to you is to seek the help of a physician who specializes in infectious diseases that are common in your area, and they will be able to put the whole group of symptoms together, not just the neurological findings, which I do not believe are isolated.

Needle EMG and Radiculopathy

Is a needle EMG always required to suspect that a patient has radiculopathy or can a Dermatomal Evoked Potential Test and/or a Somatosensory Evoked Potential test raise suspicion that a patient has radiculopathy? Can a chiropractor or a podiatrist perform a needle EMG?

Answer 1 :

Evoked potentials test the sensory roots (they go from the periphery to the spinal cord) but don't test the motor roots, those which, through the muscle, control movement. Therefore Evoked potentials can only tell you if you have a sensory radiculopathy. Only Needle muscle examination can tell you if the motor root is involved. You should also know that some studies indicate that EMGs may be (falsely) negative in up to 30% or 40% of root lesions.

Answer 2 :

For your second question, the chiropractor or a podiatrist is not allowed to perform EMG needle examination. It is only allowed and practiced by a qualified medical doctor all over the world.

30-40% false negatives

In your answer to a previous post you stated that some studies have indicated that needle EMG can give false negatives 30-40% of the time in detecting a root lesion. Why is this? Also does this apply strictly to testing for radiculopathies or other disease processes as well?

Answer :

Yes, thanks for the clarification; the 30-40% false negatives in the studies I quoted applies only to radiculopathies.
This is due to many factors, including the fact that while radiculopathies may be painful, they may actually not cause any nerve damage (which is what is picked up by the needle exam of the muscle), sampling or interpretation errors, detection error due to poor relaxation, timing of the exam etc..

Comment :

Thanks for the clarification. Are there any general statistics in regard to false negatives or diagnostic accuracy in general for EMG? Or are there statistics for individual disease processes such as neuropathies, myopathies etc?

Answer 1 :

Well, generally speaking, in compression or entrapment neuropathies (such as Carpal Tunnel, Ulnar, Radial or Peroneal Neuropathies, or Bell's Palsy), the yield is pretty high (I do not have numbers) even though there are still false negatives. In root lesions, as I mentioned before, the yield drops, as it does in neuropathies and myopathies, probably again in the 30-40% area. EMG is considered to have the highest yield in entrapment/compression neuropathies.

Answer 2 :

I would like to tackle this point by talking about how the electrodiagnosis contribute to diagnosis of myopathies in form of false positive or false negative. First of all, it is important to keep in mind, unfortunately, that none of the abnormalities in EMG is pathognomonic or specific for any single myopathic disease. Second, EMG is important but general guide to diagnosis, but we should keep in mind again that exceptions do occur. Now, the question, could EMG be false positive in myopathies? The answer is yes, due to technical reasons (MUP measurement, over-reading), also it can be false negative, due to again technical reasons (MUP measurement, simply missing mild changes) or mistaken the changes to be due other cause. Regarding neuropathy, again, false positive can occur due to technical reasons, temperature and age. While the false negative can also be due to some technical reasons in the recording.

Role of EMG in Lower back pain

Is there discomfort with EMG for lower back problems? What can I expect and what is procedure? What can EMG diagnose for lower back? Have small herniated disc L5 S1. Orthopedist can't find reason for continuing back problems. Symptoms recently changed following physical therapist realigning hip joints. Now on L side with pain on buttocks and thigh almost like a mild leg cramp when standing or sitting for more than a half hour, which intensifies with time. Relief after a few hours only by lying flat on back with pillows under thighs. If I get up to stand or sit discomfort comes back.

Answer :

EMG is important tool in diagnosis of radiculopathy. It will help you to confirm the root involvement, its level and severity, sometimes when even the imaging studies are normal. The EMG examination utilizes an electrode or needle probe, which is inserted in a muscle. It is not that bad but does cause little discomfort. This discomfort is variable between persons. But it is well tolerated in majority of cases.

Commentfrom anotherpatient :

I just read your post as I was looking up info on having an EMG test done. We seem to have identical back problems, and I was wondering how everything has turned out for you. If you should get this post, I would love to hear from you.

Commentfrom a thirdpatient :

I experienced similar pain, after pt. It should improve in a few weeks or may be a two months at most. Don't be alarmed. If the pain persists see another physical therapist, the one you saw may have over did it.

Leg tingling and numbness 6 months after lumbar fusion

About 16 months ago, I underwent Lumbar fusion on L4/5, and S1 with steel rods. I did well until about 6 months ago. I began getting tingling and numbness in my right leg. With physical activity it intensifies, so I am having a difficult time with PT. My doctor ordered a Myelogram and said it revealed nerve root interference from epidural scarring. However, I had an EMG done and it revealed no nerve root interference. Can you explain why this might be the case? I still have the symptoms, but sort of feel like I'm being second-guessed since the EMG.

Answer :

The discrepancy between your physical symptoms and the EMG findings is unfortunately not uncommon. There are several reasons for that:

One is that the EMG appropriately tests motor fibers only when it comes to root lesions so if you have primarily a sensory root lesion, it will be missed most of the time.

Two is that, even with motor root lesions, EMG can be negative is as many as 40% of the time so a negative EMG does not rule out a root lesion.

The Myelogram however (and certainly the clinical symptoms you have) are very sensitive however and I would go with those over the negative EMG. I hope this helps.

Comment :

Thank you for that response. I'll ask for a second opinion. Thanks you so much!

I failed to mention that he did a NCS too. That too, was also negative. Should that have shown some positive results?

Answer :

The answer is no, generally speaking NCS are negative in root lesions. One exception to that is some abnormalities in late responses such as F-waves and H-Reflexes.

Curious about ankle tapping during Neurological examination

During examination, neurologist detected some diminishment in right arm; he also tapped the inside of my left ankle 5-6 times (only once on right)- what does the tapping on the left ankle give clues to? Am scheduled for EMG/NCS, but curious about the ankle tapping. Hope I've provided enough info. Thanks

Answer :

My guess is he was trying to elicit your ankle reflex and compare it to the one on the right.

Right thigh numbness

I am 35 years old man; complain from tingling and needles feeling in the right thigh for the last 3 weeks. It was not continuous but for the last week it is continuous. It gets worse on standing and goes up to lower part of my back. It gets better if I bend forwards or sit down. I had surgery for my right knee last year due to ruptured ligaments (ACL). The doctor fixed nails in my knee. They should remove them next September. My knee is OK at present time. Please help. Thank you for this wonderful site.

Answer :

Your symptoms sound like a condition called meralgia paresthetica, which means a compression of a sensory nerve in your groin. This nerve supplies the front of your thigh and gives symptoms similar to the ones you describe. Treatment usually consists of finding whatever is causing the pressure in your groin and treating it and if that does not work to take some medications which will decrease the feeling. This however may also be due to something else, like a pinched nerve, so it is best if you see a neurologist to get a better idea of what's going on.

Lumbar fusion/military discharge with normal EMG but persistent pain

I had an L4/5/S-1 fusion with Texas instrumentation about 16 months ago. The shooting pain down my legs has stopped, but I'm having problems with numbness/tingling in my legs/feet, and pain that works its way downward with prolonged standing or walking. Any kind of Physical exercise exaggerates these symptoms, which makes PT difficult, but I'm sticking with it. A Myelogram with CT reflected bilateral lower nerve root impairment from epidural scarring. However, an EMG/NCS was unremarkable, an "essentially normal study", "no nerve damage". Now, I'm being discharged from the military after 18 1/2 years with no compensation for "failure to meet physical fitness standards" (3 mile run, sit ups, push ups). I Realize that you're not in the legal profession, but can you offer some explanation for my physical findings, and symptoms? Be frank please, if you think it's all in my head I need to know. That's obviously what the military thinks, and since I am not afforded any legal representation or recourse like a typical civilian would be I'm scared. I'm worried about supporting my family. I have a lot at stake here! Should I continue physical therapy even though it causes me pain and discomfort? I want to do what I need to do to get well, but I also have concerns of causing further aggravation and damage, which would only further reduce my physical limitations and impact negatively on my physical abilities once I'm discharged and have to go to work and support my family. One other thing, I just had my first epidural steroid injection yesterday. Am I wise to try these? Can they help with nerve root impairment? I'm willing to try anything, please tell me where to go for some help!

Answer :

EMG can be 30-40% false negatives in radiculopathies. As pointed out by, this is due to many factors, including the fact that while radiculopathies may be painful, they may actually not cause any nerve damage (which is what is picked up by the needle exam of the muscle), sampling or interpretation errors, detection error due to poor relaxation, timing of the exam etc. The point is that EMG, then, can be negative although there are symptoms as in your case. Although you have problem with physio, but I think very careful and gradual step by step physio may help but it is up to your treating doctor.

Commentfrom anotherpatient :

I have the exact symptoms as you do, have had EMG's done all came back normal but I insisted on MRI and found that I have degenerative disc disease, which cause what you are describing. It sounds to me that's what you need to have done is an MRI hopefully it will show something. Have they tested you for arthritis as well cause pain as you are saying also comes from that as well, Which I also have. I know this isn't really good information but hopefully it will help you with your problem and the military do go and have a second opinion done as well cause I was working with military doctors as well and it seems they got the name doctor from a bubble gum machine at times, request a doctor from the outside. Good luck on all your pain and with the military.

Strange leg numbness that spread to whole body

Seven years ago while my left leg was cramping it went numb. It has remained numb from the sciatic nerve, down the back of my leg, wrapping around the outside of my shin, including my foot bottom, except for my big toe. Most of the top of my foot is involved too. The numbness is like Novocain numbness. I also cannot feel cold in these areas of my leg and foot. The strange part comes with 'flashes' of numbness on my face and body. The other body parts included are my arms, chest, belly, and back. In May of this year my back, down my spine, became permanently numb too. This numbness in my back is the only change in 7 years. The 'flashes' come and go. I have been to two neurologists. They have said that I do not have MS. Beyond that, they (and the MD's) have been clueless. 2 weeks ago I went to have an EEG because I fainted and seized. I have never seized before. My blood tests and EEG returned normal. While getting tested, the tech. suggested I get an EMG for my numbness. It is quite surprising that this has not been offered to me by anyone else. I will speak to my MD about it soon. My chiropractor says that it hits so many nerve areas that it totally baffles him too. He has been in practice since 1962. He did a test that seems similar to the EMG at his office. I had NO response to the electrical current. I felt nothing. He was surprised because he said that I should have been jumping off the table with the varied currents he was sending through me! I get flashes of numbness too. They can be so strong that I'll be awakened out of a sound sleep. I will be curious as to what the doctor suggests causes them. Best of luck. Thank you for your informative website, as well as this forum. Do you have any suggestions from my description of numbness?

Answer 1 :

I read your post carefully. My first thought was also MS, and I take it, the Neurologists are fairly confidant that it is not. Fainting and seizures however are definitely not part of MS. Needless to say, the object of this exchange is not to make a diagnosis over the Internet, but just reading through your post, I wonder if you are having any toxic exposure in your environment. That may cause peripheral (the numbness) and central (the fainting and seizures) problem. An EMG would be helpful to show whether or not you have a neuropathy. If you do and if there is no obvious reason for the neuropathy, I would definitely look into toxic exposure (at home or at work). Good luck.

Answer 2 :

Urgent, Please reply. How long have you seen this chiropractor? I am sure that this is the source of all your numbness and pain, if you are receiving alignments. The body is only designed to withstand so much jerking and pulling. Also there are nerves and nerve roots that can be affected by frequent adjustment. I suggest you stop seeing him and see a rheumatologist, neurologist, orthopedist, and a physical therapist to evaluate your condition. If the treatment the chiropractor is giving hasn't relieved the pain or caused additional pain, give up and try something else. In the long run you will find it's cheaper and safer to do without the chiropractor.

Radiculopathy with negative EMG for nerve damage

I have constant numbness/tingling in my R LE (bi lateral at times), increased with activity. Can you explain how I can have the diagnosis of radiculopathy with a negative EMG? What exactly does it mean, and will epidural steroid injections help? Does it mean it's permanent? Also, how could a sensory root lesion be detected, by NCS?

Answer :

To explain further why the EMG is negative in some cases with radiculopathy. The medical reasons were pointed out in previous posting. But I would like to say, if you have a car with maximum speed limit of, say 120, then it cannot go faster than that. Similarly, in EMG it has its own limitations we cannot exceed. We cannot do more than what it could give; otherwise, we do not need any other tests. The EMG is complementary or extension to medical examination and it does not replace or substitute a good medical examination by all standards. To go back to your question of epidural steroid injection, it may help, and it is up to your treating doctor to decide. A negative EMG in your case does not mean that your symptoms are permanent. On the contrary, a negative EMG can be reassuring. Finally, I am sorry, I do not know how to help you with the last point.

I wanted to ask about THE EMG safety also... what is the amount of electric stimulations (the maximal) you give in EMG? (in Ampere) I read somewhere it is 10-75 MA WHICH AMAZED ME AS I KNOW A CURRENT OF 30 MA is enough to kill a person!!! So how come it is safe?? (May be it is micro Ampere rather than Milli Ampere???)

Also, Does the electricity you give really travels through our body or it just the sensory stimulation (natural) that travels?

Are there any web site with information on EMG SAFETY

Answer :

Thank you for this point. It is important issue. Your numbers are correct, in mA (maximum 100 mA), not MicroA. The point is that this amount of stimulation is given for very brief period range from 0.05-1.0 milliseconds only. There are always safety regulations and no EMG machine is approved unless it fulfills all safety rules by law. The patient safety is always on the top.

Regarding the electricity, it travels only through the nerve under study. For the web sites, I am sure there are web sites for EMG Safety but I do not recall or have any at present.

Comment :

About the safety...

Do you know of any researches about the long term effects of an EMG test (the "electric part") such as possible nerve problems, cardiac problems (that show up after long time) etc... For example with people who had several EMGs over the years?

Do you know of any short-term hazards? (Such as people who feel bad or faint right after the EMG?

* I read somewhere that increased exposure to electric shocks has been linked to a variety of fatal disorders such ALS and renal cancer... (That is why pilots get more ALS and RENAL CANCER according to this research...)

Answer :

I am not aware myself and I did not read about any long term effects of our "diagnostic" nerve stimulation electrical tests, even if several tests are performed per year for a normal person or patient in child or adult, female or male, animals or human. For short term, talking usually about minutes, pain (variable between persons), usually tolerable. I have not seen a person fainted from nerve stimulation tests. The final point, I am not sure what sort of electrical shocks and for how long the exposure to be linked to fatal disorders. It would be interesting if I can read this article.

Comment :

here is the article....

Electric shocks linked to Gehrig's disease

August 18, 1998

NEW YORK, Aug 18 (Reuters) -- A study of utility company employees in Denmark suggests a link between amyotrophic lateral sclerosis (ALS) and exposure to electromagnetic fields or electric shocks, according to a study published in the August issue of the American Journal of Epidemiology.

ALS -- also known as Lou Gehrig's disease -- is a rare, fatal disease characterized by weakness and atrophy of muscles and a degeneration of the nerves that transmit messages to muscles in the brain and spinal cord.

In the study, Drs. Christoffer Johansen and Jorgen H. Olsen with the Danish Cancer Society in Copenhagen examined National Death Certificate files for the cause of death in 21,236 men employed in 99 utility companies in Denmark between 1900 and 1993. Medical records were obtained to determine cases of ALS.
Overall, 3,540 deaths were noted in these workers, slightly fewer than the 3,709 expected based on national mortality rates. Analysis of the records revealed a twofold increase in deaths from ALS in these men and a tenfold increase in deaths from electrical accidents on the basis of 14 and 10 deaths, respectively. Death from ALS was also found to increase with time since first employment in a utility company.

"The excess mortality from amyotrophic lateral sclerosis seems to be associated with above-average levels of exposure to electromagnetic fields and may be due to repeated episodes with electric shocks," the authors write.

However, the study did not find that increased rates of other neurological conditions such as senile dementia and Alzheimer's disease in these men, nor an increased risk of suicide. Previous studies have linked these conditions and suicide to above-average exposures to electromagnetic fields.

"The pattern of mortality from ALS, however, suggests an association within jobs entailing medium to high exposure to 50-Hz EMFs (electromagnetic fields), possibly due to an increased number of episodes with electric shocks," the authors conclude.
----------------------------------------------------------------
So what is your opinion on that Doctor? Is there a great difference between the electric shocks they mention there and the electric shocks in EMG?

Answer :

I am sorry for being late in reply. I will not discuss whether the relation is proven or not, but I want to say this kind of electrical exposure (EMF) is different from that used in field of nerve conduction studies. The exposure, however, in nerve stimulation is low and very brief indeed.

Significance of low peroneal F wave persistence

Several weeks ago, when I had my EMG, THERE was a problem with the peroneal F wave bilaterally. THEY had to give many shocks until they could elicit the peroneal f wave. (Not so with the tibial F wave, which was elicited right after the first shock) - when they did elicit it, IT was completely normal on both sides - THE latency was 43 MS in the right and 42 MS in the left, WHICH is normal (IS it?) but again, many shocks were needed to elicit it. THE doctor who did the EMG told me that the peroneal F wave is always more difficult to get. * Except that, totally normal EMG I did some self research on that, yet I could not find the answer to several questions: 1. WHAT IS THE pathological significance of totally normal f wave, which is very difficult to elicit (low persistence)- this is the most important question - I could not find answers anywhere? 2. What is your own experience with the peroneal f wave - DO you also find it difficult to elicit? HOW many stimulations are needed for it in your experience (more than for other nerves) 3. Does the fact it was difficult to elicit it in both sides gives you any clue about the possible cause? 4. Position- HOW do you check for the peroneal f wave - only when I was sitting, could the doctor elicit the f wave, SO maybe it has something to do with position.. I posted on this issue in the past, yet since then I did some reading and these questions came up..

Answer :

1. WHAT IS THE pathological significance of totally normal f wave, which is very difficult to elicit (low persistence)- this is the most important question - I could not find answers anywhere?
Answer: it could happen with any disease causing nerve damage, such as neuropathy, radiculopathy. It may happen without clinical significance in practical terms, especially with peroneal nerve. This is related practically and usually to habit of sitting (squatting).

2.what is your own experience with the peroneal f wave - DO you also find it difficult to elicit? HOW many stimulations are needed for it in your experience (more than for other nerves)
Answer: It might be difficult to elicit due to previous explanation. The number of stimulation is variable, but to mention numbers, then 4-6 extra stimulations are usually enough.

3.Does the fact it was difficult to elicit it in both sides gives you any clue about the possible cause?
Answer: It may help, but we need to see other parameters and clinical history and examination.

4. position- HOW do you check for the peroneal f wave –
only when I was sitting, could the doctor elicit the f wave, SO maybe it has something to do with position..
Answer: I do not think so, position does not actually affect the F wave parameters.

I suffer from extreme low back pain and neck pain and weakness in my arms pains in my shoulders...and more. I had surgery on my back 10 years ago. I had an MRI and it shows multiple levels of bulging. I have numbness in hands and feet, sciatica,,,etc...My question is why do I have to go to a neurosurgeon or get EMG test?? I am going tomorrow for the neurology tests. However I already met with a neck surgeon who said he would be happy to operate on my neck...He didn't need Nero tests???? It seems to me I should see a orthopedic surgeon not a neurosurgeon...I heard that neck surgery may stabilize a back...Is that true??? The multiple levels of bulging are in my neck...

Answer :

Various doctors rely on different tests to establish a diagnosis and it may well be that in cases like yours, there are too many doctors involved in the care who might not know what the others are thinking. It is always best to narrow down the number of doctors you're dealing with to avoid such situations.

EMG of Soles of Feet

Is nerve conduction of soles of the feet subject to the same limitations as the needle exam? Is the 47 m/s normal conduction velocity limit for index to palm applicable to the LL?

Answer :

In answer to your questions:

Nerve Conduction of the soles of the feet (for plantar nerve branches) is not subject to the same limitations as the needle exam of muscles. There are well-described techniques and normal values for that.

As for your questions about a 47 m/s index to palm conduction, it depends on what the normal values are for the lab that did the study (depends on machine, electrode position, stimulation paramaters etc.) and that's the real gold standard. In our lab, this value is within normal limits.

Comment :

Thanks very much for your response. This is a very helpful site. Here are the stimulation parms... I tried to scan the image but scanner is not working....

The lab indicated a temp of 33.6 C, though I do NOT remember them ever putting a thermometer on my hand. My hands felt very cold. I'm 6' 3" tall.

The lab that did the recording concluded that sensory Nerve conduction was 'minimally' slow with motor conductions/f-waves normal. They diagnosed a peripheral neuropathy. The folks in Boston (Brigham and Womens) reviewed it and said that it all appeared quite normal. B and W also seemed a bit concerned about the accuracy of the temp.

If this information is enough for you indicate normal/slow, then great. If not I understand perfectly. I'm just trying to get a sense for whom to believe.

Thanks again for your time and effort and particularly patience,

Answer :

Again these values are different from Lab to Lab however in my Lab these figures will be within the normal limits.

Comment :

Thanks much. What I have learned from going through this is that it is of critical importance that Drs and Techs have an extremely high level of training on EMG/NCS technology. This is NOT straightforward material. I am very grateful of the time and effort you have put into answering my questions. Great Web site !!!

EMG report for suspected herniation of lumbar disk

I have suffered from low back/left leg pain for over 9 years now, and was finally, after much misdiagnosis, diagnosed with a herniated L4-5, and bulging at L3-4 disk. They wanted an EMG done prior to approving the surgery and it was done. I got a copy of the report, but don't understand it. It says the "EMG revealed no evidence of radiculopathy, neuropathy or distal nerve entrapment of the lumbosacral spine and both lower extremities." What would normal EMG numbers be?

Answer :

As I read the narrative of this report, the doctor is saying that no abnormalities were found in the test, which is usually another way of saying that the test is Normal.

Atrophy of Leg

My eighteen-year old son's left calf is 2 3/4" smaller in diameter than his right calf. He is unable to raise up on the toes of his left leg and has no achillies reflex. He experiences almost constant lower back pain, and significant knee pain due to hyperextension of his knee with each step he takes. He has had an MRI of his lower spine, which showed no tumors, and has now had a pelvic MRI, which we are awaiting the results on. If this MRI is also clear, what would your next plan of action be to determine the cause? He is a 4-year letterman, 2-year all-conference football player. The two doctors he has seen have both been amazed at his ability to play football so well, given the extent of the weakness in this leg. Basically, they have both said, "I wonder how great a player he would have been if he would have had two legs to run with." He has been selected to play on the Southern Colorado football team in the Down Under Bowl this summer. We would really like to get to the bottom of his leg problem, send him to Australia, and out into the world healthy. Thank you for your consideration.

Answer :

EMG is useful to perform in your son to confirm or exclude nerve damage. This would also help to determine the level and severity of the lesion. Also, it is true that some patients have asymmetry of legs (atrophy) but it is really amazing how such muscle can compensate to do its function. Please keep us updated if EMG or other studies are done.

Comment :

Just from reading your description, I was thinking the MRI of the low back was going to show a disc (L5-S1) because of the history of back pain, calf wasting and inability to raise up on the toes on the left. You say the MRI showed no tumors. I take it no discs either. That's probably why they are doing a pelvic MRI to see if there is anything in the abdomen pressing on the lumbosacral plexus (https://www.teleemg.com/Anatomy/Nerves/LSPlxAnat.htm).

A good EMG would be very helpful in cases like this as it will:

a) Show the amount of nerve/muscle damage (and whether it is recent or old) and

b) Localize the damage to the roots or lumbosacral plexus (or elsewhere)

That would be very useful information at this point.

Answer 1 :

My son's pelvic MRI also came back negative. The EMG has shown the doctor exactly where the nerve damage is in his calf. The EMG also showed another problem. The doctor doing the EMG told me that the standard for EMG's was to measure the time it took for the electric impulse to travel 15 centimeters. He said the normal response time was 3.5 milliseconds. I do not know what the response time was in the atrophied leg, but the doctor found an average response time of 4.22 in both his arms, and his normal leg. Just when we thought we might be at the origin of the problem, another detour has presented itself. Now the doctor has ordered the following blood test:

The doctor did not want to explain too much as to his reasons for wanting this blood work. He said he was so sure that one of the MRI's was going to show a tumor or growth that he feels very bad about conveying his feelings of that being the probable results and does not want to "overload" us with more information and possibilities at this time. I am now almost wishing there would have been a tumor. At least that would have been something we could have surgically repaired. Now the great unknown is the scariest.

Please continue to relay any thoughts or views you may have. Right now I need all the support and encouragement I can get!

Answer 2 :

I think your Doctor is right. He's trying to find all the information before he can give you a final answer. Doctors don't like to give partial answers only to retract them afterwards when the tests show otherwise.

It would be helpful to know what exactly was the abnormality seen on the EMG.

Comment 1 :

Our next appointment with the doctor is February 9, 2001. At this time he will go over all of the test results with us. He also wanted the two weeks to go over the two MRI's, the EMG, x-rays, etc., and hopefully with a view of the total picture, reach at least a tentative conclusion. He is doubtful that the results from the blood work will be back by this appointment, but in speaking with the lab personal, the results could very well be back.

Once again, thanks for your feedback, and I will update with all new information I receive.

Comment 2 :

The blood work and urine sample all came back negative. The doctor has concluded that my son suffers from peripheral neuropathy. He said that 45% of neuropathies are caused from diabetes, the arthritis family, etc., 5% are caused by cancer, etc., and the remaining 50% is of unknown origin. He believes my son falls into the latter group. He wants to do another EMG in three months to determine if there is any continued atrophy, and wants us to contact him immediately if my son experiences any unusual symptoms, like excessive thirst, tingling or strange sensations, weakness, vision problems, etc. In the meantime, my son still experiences back pain, and is wearing three heel lifts in his left shoe to help with the knee pain. Should I get another opinion, or do you feel all has been done that can be done at this time? Should my son just learn to live with the pain and discomfort?

Answer 1 :

Thank you for the update. Although we do not have full details of EMG but his doctor has diagnosed peripheral neuropathy, which is frequently easy from clinical examination and EMG. Having said that, it is not always easy to find what is causing this peripheral neuropathy. Although, it is sensible to follow the advice of the doctor, but it is not too bad to seek second opinion of a neurologist if possible.

Answer 2 :

Thank you for the update. Although we do not have full details of EMG but his doctor has diagnosed peripheral neuropathy, which is frequently easy from clinical examination and EMG. Having said that, it is not always easy to find what is causing this peripheral neuropathy. Although, it is sensible to follow the advice of the doctor, but it is not too bad to seek second opinion of a neurologist if possible.

Pain after hip replacement surgery

I had hip replacement surgery in Dec.00 Since then I have Jabbing pain sometimes severe in my groin & radially around my hip joint. It in no way effects the muscles, which have become stronger due to exercises, suggested by my physical therapist & also the rehab I attended. I had a spinal anesthesia for surgery. I'm wondering if my femoral nerve could be affected? Maybe there are other possibilities? I've been back to the surgeon once since surgery & the X-rays look normal & he was satisfied. How ever I do have the recalled Sulzer part that may have had the excess oil on it. The symptoms for that defect are supposed to show up in 6 to 8 weeks & cause pain & inability to put weight on the leg. I've had the pain since surgery but am able to walk without pain.

Answer :

It seems that the pain is still related to your hip joint, although not significantly affecting your walking and your doctor was satisfied, and X rays fine as well. Also, your muscles are fine, therefore, femoral nerve is unlikely to be affected from your description. Femoral nerve affection would cause weakness especially on going upstairs or getting up from sitting position. Also, it would leads to atrophy of front thigh muscles, and it seems that you do not have those.

Thigh pain after EMG

I just had an EMG done, and ever since then, I have had some moderate to severe pain in my left thigh. I had no pain there before the test, which was quite painful. The doctor who performed the test doesn't know why I would have this pain. Is this a common side effect of the EMG? If so, how long can I expect it to last? Any help you can give is greatly appreciated, and I look forward to hearing from you.

Answer :

The pain or discomfort at the site of EMG insertion may last minutes and up to few hours and very rarely up to 24 hours. If it is longer or moderate to severe, another cause should be looked for. However, you did not mention how long you have this pain following EMG and why, to start with, EMG was performed?

LL weakness & EMG findings. Is it ALS?

Hi. I have been having progressive lower extremity weakness over the past three years. I have seen 3 ortho doc's thinking it was my knee (I have a chronic ache in my left knee). Two days ago I underwent EMG and nerve conduction studies (very painful). The nerve studies were normal. The EMG revealed Fibrillations and positive waves in my calves, supraspinous muscles and deltoids. There was very little muscle fiber in my left calf. Are these findings consistent with ALS? How about MD? I am a 29-year-old female. What other testing can I expect?

Answer :

On one hand, the EMG findings are incomplete to draw a conclusion i.e. the motor unit potentials (MUP) description. On the other hand, the EMG findings must be taken in context of the clinical picture (history and examination) and not on its own, because those may suggest any of them or other diseases. I would recommend seeing a neurologist (if you have not yet seen one) before proceeding with other investigations.

Severed common peroneal nerve

My sister endured a spiral break of the left fibula back in December. She experienced severe swelling and although the bone is now healed she is still not able to walk. A recent EMG test revealed that she had severed her common peroneal nerve, deep peroneal nerve and superficial peroneal nerve. I want desperately for her to regain full use of her leg and the ability to walk and run. can someone please advise us as to where we can find the best doctors and treatment? Many thanks!

Answer :

The severity of the injury to common peroneal nerve is an important factor to determine the prognosis or recovery after the lesion. A severe lesion may take quite long time (months) to observe any improvement. There is still time and hope for recovery because she had the trauma in December. Follow up EMG can help to show any signs of recovery. She needs physiotherapy. Also, she needs to consult neurosurgeon or orthopedic surgeon but I have no names, it depends on the state you live in; all have. I hope this is helpful.

Comment :

Thank you so much for getting back to me with the valuable information. My sister did see her doctor today and he set up appointments with a neurologist and physiologist. I'm glad that you had made similar suggestions. We realize, however, that time may be of the essence. She was told that if any surgery is possible it would need to be done within three months of the trauma. We live on long island, in a suburb of new York city. Do you know of any hospitals and/or surgeons who have performed this type of surgery? We would also be willing to go out of state. We just want the best for her. Many, many thanks for your help.

Answer :

I am trying to get some doctor names. I will come back to you once I have any.

Comment 1 :

Yesterday I went with my sister to the orthopedist and a vascular doctor. The orthopedist did not recommend surgery. He said that the EMG shows that she has 30% connectivity, which explains her ability to move the foot a little. He also said that the damage was done to the microfibres within the tibial nerve and that these microfibres are much too small to perform surgery. He recommended a brace, time, and physical therapy to regain more mobility.
The vascular doctor feels that there may be some kind of blockage in the front of the foot preventing nerve connection. He also mentioned something about the "sympathetic system" playing a part in her inability to increase strength and mobility. He recommended a cortisone shot in the foot to wake it up so to speak and improve circulation. First, however, he wants her to see the neurologist.
She has an appointment this morning with the neurologist. Does any of this make sense? Do you have any suggestions for treatment to maximize her mobility? Is there anything else she should be doing to protect herself from further damage?
We are very grateful for any information you can provide. Have a wonderful day.

Comment 2 :

My sister met with the neurologist this morning. The neurologist mentioned that my sister might have RSD. What is RSD? How is it detected? How is it treated
I apologize for all the questions. We just feel so overwhelmed, and we just want to make sure that my sister is being advised properly. We don't want to find out months from now that she should have done something else

Answer :

Many patients complain of chronic pains associated with motor and sensory symptoms, often associated with "autonomic" features. This pain is considered as reflex sympathetic dystrophy=RSD which is really symptom complex, and it may come as post traumatic pain. It may also come with illnesses such as neuropathy, plexopathy, radiculopathy, myelopathy. The term RSD is sooner or later offered as a fallback diagnostic alternative in many patients. The issue has been addressed by the International Association for the Study of Pain (IASP), and it has renamed RSD as " complex regional pain syndrome ", which is, in fact, more descriptive. Generally, the pain of RSD often seems to be out of proportion to the severity of the injury in both its duration and intensity. Characteristically, it is burning or deep aching pain. There are several tests could be done but its diagnosis is basically depends on clinical grounds and by excluding other possibilities by the treating neurologist. There are non surgical and surgical modalities are offered for treatment. The treating doctor may be able to decide and it can be successful. I hope this is helpful.

Comment :

Thank you very much for the information. It is extremely helpful. My sister visited a neurologist in NYC, and he is not sure whether she has this RSD condition or not. My sister has the burning, lack of mobility, and discoloration of the foot, with extreme temperature fluctuations, but she does not have the chronic pain.

She is undergoing intensive physical therapy, and the doctor feels that in time the nerve will regenerate. He said that the nerve regenerates at approximately 1mm a day. We're hoping that he is correct.

Do you have any advice on what she can do to help her body heal?

Thanks again for your time and knowledge.

Commentfrom anotherpatient 1 :

I severed my calf and peroneal nerve eleven years ago. About 10 months after surgery and while in PT I was able to pick my foot up for the first time. I never regained full motion but did get it back to about 70 % and was able to stay active without the drop foot brace. However, about 4 weeks ago I hyper-extended my knee pretty badly and have once again lost most of the feeling on the side of my leg and in the top of the foot. I've also lost the ability to lift my foot. It was frustrating trying to find a Dr. but was finally able to do so @ Stony Brook hospital. I am going for an EMG and nerve conduction study in another two weeks to see if surgery may be necessary. Anyway, I'm confident since I was able to get function back the first time and truly believe that physical therapy had a lot to do with it so make sure your sister goes religiously. If anybody else reads this and has any knowledge about this subject than please let me know. Thanks

Commentfrom anotherpatient 2 :

You might want to check out www.mybrokenleg.com
I too have a broken leg and I don't know how I would have made it without that site. There are diaries, links, and the best discussion board. I recommend you posting on that site as well as this one. Chances are you will find the answers you looking for. Everyone there can relate and they are very helpful and knowledgable. Check it out! I highly recommend it. Best of luck to you.

Treatment following crush injury in the foot

2 week ago my husband managed to run over my son's foot with the car. Very little swelling and bruising. X-rays + bone scan show no fracture. However he still cannot bear weight on that foot, plus it hurts constantly, and the slightest touch causes him extreme pain. Currently taking Darvocet for pain, but not during the day as it sends him to sleep (not that it helps the pain much anyway). Saw the orthopedic surgeon yesterday, who told us to make sure he keeps it moving, and see him in 4 weeks if it doesn't improve. I asked if it was possibly nerve damage (he was very patronizing - what nerve would that be? but that's another story). He said no tests could be done for 2 more weeks even if it was. I asked if he should see a neurologist, told that it wouldn't be very interesting to a neurologist at this time. My questions are these - is it true that we need to wait a further 2 weeks? Should we arrange for him to see a neurologist? Is there anything more that any type of doctor could do for the pain at this time?

Answer :

In instances like your son's case, it is more likely that the pain is due to bone/tendon/ligaments swelling and bruising rather than nerve injury, even though small nerves in the foot might contribute to that. There may be enough soft tissue damage to account for the whole pain however.

The remark about two weeks probably refers to the fact that nerve damage takes about 2-3 weeks to be visible on EMG, when this diagnostic test can be useful.

At any rate, in my own practice, I advise patients to seek the opinions that they think might help. Some times patients know better than doctors and it never hurts to look.

Comment :

Thank you very much for your fast response. If it is bone/tendons/ligaments damage, would not there be swelling obvious, or is there sufficient room under the skin for this type of damage to occur without external signs? Can I assume that if it is this type of damage it will eventually heal without further treatment? I have no desire to put my 11 year old through more stress if it isn't necessary.

Answer :

The swelling usually subsides within the first two to three weeks and the pain may be caused in instances like this by the joint movement against these structures. Orthopedic surgeons usually see and treat a good deal of cases like this and the recommendation of keeping it moving and waiting it out for four weeks with everything else being negative is in keeping with the managing of injuries such as your son's.

Is there alternative for surgery in S1 radiculopathy?

I just had an EMG with the result showing left S1 radiculopathy. I herniated L5-S1 disc 12 weeks ago and have been doing home traction. I have improved some but there is still talk of surgery. Does surgery always have to be done for this? How long do I have before permanent damage might be done? I really want to avoid surgery if at all possible. I am 47 years old and otherwise in very good health. Any thoughts??

Answer :

Well, these are always tough questions. First things first: You ask about nerve damage. A combination of the information from the EMG and MRI (as well as the clinical exam) should indicate whether or not you have sustained nerve damage and how much of it and whether or not it is healing. Second, some discs, left untreated are known to heal on their own, surgery is not always indicated. The decision for surgery involves many different steps, such as, is there evidence for healing (usually may take up to 6 months, albeit not with the same intensity of symptoms), can the patient afford to live with the pain/discomfort or incapacity for all this time, is the subject in good physical condition, will the damage to the nerve be irreprable if sugery is not performed etc.. Finally, it's up to the patient, armed with good information, to decide, and most surgeons would like the patient to be convinced before they intervene. Best of luck,

Commentfrom anotherpatient :

So much in common, you and I. I'm 44 and last summer I also was diagnosed with lt. S1 radiculopathy. I'm an EMG technician, so I was afforded the luxury of many neurologist friends rushing to my aid. I had 6 weeks of symptoms, pain in my back and leg, numbness down the back of my leg to the little toe side of my foot, and weakness that prevented me from raising up on my tip-toes. Massage, ice, heat and traction was attempted, but to no avail. My neurosurgeon reviewed my MRI which showed a large herniated disk--his opinion being that it was too big to "suck back in" on its own. I had surgery--3 hours, including recovery room time. After about a week of recovery, I was moving around with much less pain. The weakness gradually left in about another 3-4 weeks. The numbness took longer...about 3 months for all of it to go away. I still have fleeting back and leg "aches", but nothing like the radiculopathy pain. I believe, because of nerve damage that may have been done, that these "fleeting reminders" may not permanently leave. My advice to you would be that if your symptoms are pain only, and can be managed in some other way, that surgery may not be the way to go. BUT, I think that numbness or weakness may be the hint that maybe surgery can at least prevent any progression.

Possible causes for foot drop

My husband has experienced foot drop and numbness from mid-calf through ankle on his left foot for about a month. Two weeks ago, he had a Nerve Conduction Study, and the physician doing the test suggested he had injured his peroneal nerve: he said the charge "decreased from 64 to 40, calculated over 14 centimeters". (I may have this wrong, as I'm just reading from notes.) Today, though, my husband had a follow-up with his internist who said his blood tests came back border line for lupus. He was also referred to a neurologist. I understand that the possibilities range from neuropathy to MS or even ALS. Can you give me any guidance about what we can expect from the neurologist? (This is the same neurologist who treated my mother for a malignant brain tumor, so I am terrified.) Thanks so much for your help.

Answer :

I do not think there are any evidences from your email to suggest MS or ALS. The peroneal nerve injury is not a serious problem. Perhaps the neurologist would reassure you regarding the peroneal nerve after full neurological examination. He may need to check into borderline results of lupus.

EMG and Nerve Conduction report interpretation needed

Please help, Can anyone define and explain to me what this report means? EMG: This study provides electrical evidence to support mild chronic left L-5- S1 radiculopathy without acute on going denervation. Nerve Conduction: This study provides electrical evidence to support a left posterior tibial motor neuropathy with proximal involvement. The prolongation of the left H-reflex suggests an L5-S1 pathologic process.

Answer :

Before I do interpretation. Please let me explain that EMG reading or interpretation depends generally on presence or absence of certain discharges (denervation activity), which usually suggest acute lesion in radiculopathy, and changes in the motor unit potentials, which helps to see the degree or duration of lesion. Therefore, if you have only motor unit changes of chronic nature without denervation activity, then this could explained that the lesion in chronic. The prolonged H reflex also supports that the lesion is in S1 distribution. I hope this is clear. I will be happy to help further if needed.

I am experiencing numbness, tingling in my right ankle and top of foot and big toe. My doctor has me set up for a Nerve Conductive Velocity Test and EMG on April 10. Can you tell me what to expect? Will the EMG just be done on the ankle area? My internist said my problems could be bone spurs in ankle or even some problem in spine. I am just wondering if test will cover spine too?

The EMG will also explore problems originating from the spine as well, not just the ankle.

Comment :

I just had my first NCV and EMG this week. I had reported a problem predominantly in the lower left leg. The NCV was performed on the left leg, front and back, but not the back itself. The EMG was performed on the leg AND the lower back. I suspect the EMG involved the spinal area since it's the root of so many nerve problems. I'm also going for an MRI follow-up per the good doc's recommendation.

I have twitching in right leg. Am I considered as having ALS?

I am quite nervous about this twitching I have been having in my right calf, along the side-front. You can see it jumping around. It's 24/7. It's been going on for about 2 months and progressively getting worse. I also have some twitching in my right arm and right buttocks, but not as severe. It never lets ups. I have a crampy feeling in the backs of both legs at times. At one time, my right calf felt as though it had a cramp, but it really wasn't a 'cramp'. Almost a burn. Also, my left shoulder seems to want to pop out of it's socket in the morning. It feels as if there is a torn tendon or something. I see no atrophy and it feels as strong as the right shoulder. I have no weakness that I can tell. I went and saw a neurologist and he saw the twitching and said it was nothing to worry about and said; "YOU DO NOT HAVE ALS!", firmly and positively. I completely disagreed about not having an EMG, so he finally gave in. I found this very strange. I am very scared about ALS and my doctors ability. HE comes highly recommended and has diagnosed about 20 ALS patients in his life. Should I be concerned?

Answer :

Neurologists rely on many symptoms and findings to diagnose or rule out ALS. While twitching in the muscle (facics) can be a sign of the disease, not everybody who has them has ALS. If your doctor is familiar with the disease, the chances are he's confident in what he's telling you and you should feel assured. If not, you should seek a second opinion to allay your fears.

By the way, did your doctor tell you what he suspected as the cause of your symptoms?

What exactly happens to give pins and needles sensation?

When you experience the sensation of "pins and needles" what exactly is taking place? Is it a result of the healing process of the nerve or is it a result of damage to the nerve. I know when your foot is "asleep", the pins and needles come after the numbness but before normalcy, as your foot recovers......so I am wondering if the sensation might indicate a reactivation of proper nerve impulses? I'm experiencing pins and needles in association with lyme disease and am wondering if this could be the reawakening of my damaged nerves and thus a good thing.....or does it result as my nerves are damaged, and thus a bad thing? Thanks. Ruth.

Answer :

This is quite interesting question. Any or all of the sensory symptoms (pins and needles) and signs are considered diagnostic for a dysfunctional sensory nervous system or point that some thing going on with sensory nervous system. It could either occur at start or later in the process of nerve affection. Although pins and needles may get less with recovery. But does not basically or necessarily be a bad sign.

I have itchy legs when exercising. Is EMG needed?

For a long time I've been experiencing a symptom but can't seem to find any reference to it. Does anyone know what could be causing this? When I walk or run in coldish weather (anything under about 70 degrees), the muscles in my thighs and butt get this intense itching feeling (like a "deep muscle itch"). Once it starts, the only thing that seems to help is stretching the muscle, but as soon as the muscle is contracted again, the itching returns, unless I go somewhere warm and stretch for several minutes. I only know one or two other people who've ever experienced this - all women. I know I have poor circulation generally (my hands and feet are always very cold). Is this related to that, or is it something more specific? Is there anything that can be done about it? (I apologize if this question isn't directly related to the web forum - I wasn't really sure whom to ask...)

Answer :

Although your symptoms are unusual. But I feel that EMG should be performed in your case to exclude some form of uncommon muscle disease. Consult a neurologist beforehand.

Peroneal nerve injury or knee problem?

I hurt my leg skiing a year ago March. I hyperextended my leg and felt a pop on the outside just an inch or two below my knee. I had thought it was healing but as of December, all the pain returned and much more. I have had nerve conductor tests, knee strength tests and x-ray of knee. They all check out fine, actually the neurologist and orthopedic doctors say everything seems strong. But I have this radiating pain down the outside of my leg onto the side and top of my foot. At times pain also circles around the backside of my knee, too. The doctors can't find out what's wrong. I have done some research and it seems to be the peroneal nerve right where it splits below the knee that is the culprit. The pain is much worse at night when I lay down. There is not a comfortable position. Sleep is difficult. I am having an MRI on Monday, but the orthopedic doctor doesn't seem hopeful that it will show any thing. I have had it suggested to go to a physical therapist who is familiar with many types of nerve injuries. Can anyone shed some light on this injury? Can the peroneal nerve produce pain without foot drop and symptoms I do not have? I have never had back pain with this or pain above the knee and have always felt this pull on my leg at this spot I think the peroneal nerve splits. This pain and discomfort has been the same from the very day I had the skiing injury. Looking for relief.

Answer :

Your description sound like a knee and not peroneal nerve lesion. I would have thought that MRI of the knee is helpful or at least would make sure whether the knee is affected or not. Physiotherapy should also help.

How useful EMG testing is for the diagnosis of Adhesive Arachnoiditis?

I found your site while researching the question of how useful EMG testing is for the diagnosis of Adhesive Arachnoiditis and radiculopathies in general. I realize that an EMG cannot identify the precise cause of a radiculopathy, i.e. protruding disk, annular tears, etc. However, I understand from the information presented on this site that even routine EMG's can indicate problems with at least certain nerve roots for both sensory and motor radiculopathies. Arach causes multiple sensory and motor neuropathies and the nerve roots involved are often those you mention in regards to EMG testing. However, it is almost the rule that the members of the support group I belong to have normal EMG results. The only exceptions appear to be when arach has been present for a long time and/or there is a lot of wasting. Could you shed some light on this? Also, are there special studies that could be done in the legs to indicate nerve root problems in the lumbar spine? Thank you for providing this very comprehensive site. I especially appreciate the forum service.

Answer :

EMG and nerve conduction studies can help to confirm the presence of root lesion. It can also localize the affected root and how many roots are affected. It can also show how severe the lesion is. But as you said it cannot tell between causes of such lesion. This study can help in cervical or lumbar spine. However, in suspected case of arachnoiditis, paraspinal muscles EMG changes may be bilateral and at several levels. Other neurophysiological tests are less sensitive such as somatosensory evoked potential.

I have a herniated disk in my lower back, L5, S1 why won't the Dr give me something for pain?

I have a herniated disk in my lower back, L5, S1 NC/EMG showed: Bilateral S1 Radiculopathy Left common peroneal motor axonal neuropathy Bilateral posterior tibial motor proximal amplitude attenuated Left L5 radiculopathy cannot be ruled out. I am in excruciating pain in my right leg...it is constant, unrelenting and nothing they have given me so far will relieve it. I am currently taking Robaxin 500 mg 3 times a day and Mobic 15mg. once a day. I don't understand why there is not something they can do to give me some relief. Is there a reason they do not like to prescribe something to help with the pain??

Answer :

To continue the comments from previous email (same patient I guess), consultation with a neurologist, neurosurgeon or orthopedic doctor would help (second opinion). Sometimes, pain is quite severe. It is however, up to the treating doctor to try different kind of medication or alternative approach such as surgery.

Q1. What does attenuated mean??
A1. It means that response amplitude is low, this may happen with nerve damage by any cause.
Q2. Bilateral S1 area shows occasional fibrillation and potential spike. Again what does this mean??
A2. It means that muscles supplied by a nerve(in your case S1 nerve root) showed on EMG examination some changes or abnormalities indicate pinched nerve.
Generally, the results of attenuated (=reduced=low) amplitude of the nerve responses with the fibrillations and positive sharp waves and abnormal H reflexes can all be explained by the L5 and S1 nerve roots lesion in both sides, central disk or cauda equina. We need to have the sensory responses. I think the findings cannot be explained by the left common peroneal nerve lesion. However, a consultation with neurologist is recommended if you have not seen one yet.

Plantar Sensory Nerve testing

My EMG report reads 'right lateral plantar sensory response was unobtainable." I had one doctor tell me that nerve is on the bottom of my foot on medial side. Another doctor told me that this nerve is on the outside (lateral side) of my ankle/foot running along the underside of the bony protrusion of the ankle bone. My pain is in the later area. Which one of these doctors is right? Also what could cause the EMG reading that I have?. A bone spur was removed from the cc joint area on the lateral side of the foot 4 years ago and I have been in pain ever since. Any information would be quite welcome.

Answer :

The lateral plantar sensory nerve is, as the name indicates, on the outside (lateral) side of the foot. It is a rather small, hair thin nerve, which supplies sensation to that area of the foot where you have symptoms. It may very well have been injured or damaged from the surgery 4 years ago. One way to be sure, is I try to record the lateral plantar sensory response from the other foot. If it is present, then your problem on the right side is probably due to local causes (such as the surgery). If it is absent, then this may be due to other more generalized causes such as peripheral neuropathy, diabetes etc.

Myelogram

I just got my myelogram back reads: Extradural defects located at the C 5/6 level of disc. What does this mean?

Answer :

The result of the myelogram would indicate that there is a sort of pinched nerve at that level (C5/6), which is the upper cervical level. This result should be taken into consideration in your further management after your doctor has looked at the myelogram films.

EMG in pelvic floor pain and spasm in 4 year old child

My 4-year-old daughter suffers from pain "spasms" that have been identified through urodynamic testing as irregular muscle contractions in the pelvic floor. She has had 2 serious bladder infections and has a great deal of pain going to the bathroom. The spasms also happen at other times. Her neurologist has recommended an EMG to evaluate the muscle functioning. Have you ever encountered this? How would the abdominal/pelvic muscles be evaluated?

Answer :

I am not too sure what is causing pain "spasms" in your child. However, it could be related to serious bladder infection. The EMG of either abdominal or pelvic muscles could be examined by needle electrode. The abdominal muscle is not a regular muscle to be examined in EMG laboratory, but fairly easy to do by electromyographer hand and even pelvic muscle is more frequently examined in EMG lab. A reflex pelvic muscle activity can also be examined by applying little electrical pulses. It is up to examiner to decide about this. All the best.

Possible causes for foot drop

My husband has experienced foot drop and numbness from mid-calf through ankle on his left foot for about a month. Two weeks ago, he had a Nerve Conduction Study, and the physician doing the test suggested he had injured his peroneal nerve: he said the charge "decreased from 64 to 40, calculated over 14 centimeters". (I may have this wrong, as I'm just reading from notes.) Today, though, my husband had a follow-up with his internist who said his blood tests came back border line for lupus. He was also referred to a neurologist. I understand that the possibilities range from neuropathy to MS or even ALS. Can you give me any guidance about what we can expect from the neurologist? (This is the same neurologist who treated my mother for a malignant brain tumor, so I am terrified.) Thanks so much for your help.

Answer :

I do not think there are any evidences from your email to suggest MS or ALS. The peroneal nerve injury is not a serious problem. Perhaps the neurologist would reassure you regarding the peroneal nerve after full neurological examination. He may need to check into borderline results of lupus.

Value of EMG in monitoring syringohydromyelia (mine in the conus medullaris)

Was diagnosed with cystic dilation of the spinal cord in the conus medullaris (lumbar spine, 2 cavities) in 10/1999. Have had problems (and horrible flare-up episodes) for well over 10 years though. Am now 36. Plus there is degenerating disc (herniated) at L5/S1 where I have a spina bifida occulta (hemangioma also marks the spot) a 1cm left leg-length difference and the sacro-iliac joint has "jumped" a few times, and the facet joints show arthritic at L5, L4. I might sound a bit of a croc but I did lead a pretty active life until some 18 months back, flare-ups aside. My question: I have often during these flare-ups of pain, burning into my stomach, stabs just below my ribs, to the left and right, and gnawing in my back "kidney area". I was seen by a gastroenterologist a few weeks ago and had all the tests (echography, blood tests, endoscopy. They came back "super perfect" and he thinks the pain is coming from my back. This pain into my internal organs is also usually accompanied by horrible aching into my legs. So basically everything below 2/3rds of my torso hurts when I get a "crisis" and I get very panicky then. A narcotic (pentazocine) plus voltaren (injected into my bum) enabled me to sleep but the pain kept coming back for about 5 days. Can an EMG with the needles placed in my scalp and in my thighs and calves detect nerve irritation occurring mid-torso level? Or should they be placed in a different way to help get to the bottom of this pain that goes into my internal organs. With syrinxes (SM), I know the cavities can heal, but wouldn't there be some trace left on an EMG? The reason I ask is that back in February 1999 (having had a bad episode of pain early January and having even been in the hospital for at total of a week at the time!)the EMG was very good. So can the syrinx in my spinal cord at lumbar level be causing all this pain but the EMG doesn't/can't detect it? I have always been a hardworking, self-motivating individual and enjoyed good jobs but now it is my body and pain that determines what I do. I haven't worked for a year and every time I get more active, all the problems come back. So I try and be a useful member of society by doing a bit of charity work from home when I am able. I find it is also good for my moral. I am going to be monitored by EMG again this coming Tuesday (16th January)but honestly if it comes out very good after the last episode of pain (some 9 days ago) that had me going to the ER on a Sunday evening and being put on a pretty strong narcotic I will go spare. I know syringomyelia is a complicated disease but surely if it causes so much pain, the root cause must be detectable by a machine like EMG. The MRI scans show the syrinx but I was told EMG is best used to monitor it. But can the pain it causes be independent of the change in size. Do you see where I am coming from? Thanks in advance for your help.

Answer :

EMG can evaluate all muscles of extremities but not the scalp. Certainly, EMG can monitor and detect a damage or pressure on nerve roots caused by SM. It seems that several of your symptoms can be explained by SM, but is up to neurologist to finalize that.

Need For EMG due to multiple sensory & motor complains

I was referred to a neurologist who has ordered an EMG but I am reluctant to schedule it. Briefly, symptoms for several years have included episodes of numbness in face, arms, and or legs (uni- and bi-lateral), extreme fatigue/weakness in primarily legs, arms secondary (episodes where extremely difficult to get up stairs), "heaviness" in legs, hand tremors, constantly dropping things, loss of balance and coordination. An MRI brain scan showed 1 lesion in deep right frontal lobe with differential of demyelination (no trauma history). I have an ongoing history of recurrent positive EBV. MS has been mentioned by my PCP. The Neurologist mentioned peripheral nerve disease but I don't see how it fits with some of the symptoms. I haven't seen EMGs noted as a primary diagnostic tool for MS. Would an EMG really be of any benefit? Any input would be greatly appreciated - Thanks!

Answer :

The EMG is not helpful in the evaluation of chronic fatigue syndromes (unless it is due to a neuromuscular transmission disorder such as myasthenia gravis). It would be useful however in detecting any nerve disease causing the numbness you describe and or the presence of muscle disease, which is causing the weakness and heaviness in the legs.

MS cannot be evaluated by EMG because MS is caused by a demeylination at the Central Nervous System level which is not investigated by EMG.

Comment :

Thank you SO MUCH for your quick and thorough response! You provide a great service to the public and are a rare person in the field of medicine. In spite of my experience as a medical research writer, determining how to handle your personal health care can be quite challenging! Based on your response, I guess I should probably go ahead with the EMG. You mentioned CFS, and because of my background, I was able to locate one of the leading specialists at National Jewish after researching CFS and noting similarities to my problems. Of course, I've been on the merry-go-round of tests in order to rule out any other cause. If you think the test is worth a shot, I'll go ahead! But, if you think otherwise, let me know. I'm quite tired of diagnostic tests!

Answer :

You're welcome. At the bottom least, a negative EMG will rule out any "peripheral" cause of your symptoms. A positive one may help in addressing those, which can be treated.

Nerve Pain in Both legs and tingling with doctors saying it's alright

I have pain and tingling in both of my thighs. But recently I've been feeling the tingling in my fingers and other parts of my upper body. I'm really starting to get concerned because I've been to my primary doctor at least ten times and a neurologist at least four times and they found nothing wrong. Well I know I'm not crazy and I'm not one f those people who goes to the doctor for every little ache. THis is serious because I KNOW something is wrong. I eat right, exercise, and is a very active person. I even take vitamins and minerals as a supplement. So totally confused and worried.

Answer :

It would be good to have nerve conduction and EMG at least as a baseline studies. However, it might be difficult to point to the cause of your problem. I think, second opinion with a neurologist is worthwhile.

S1 radiculopathy and EMG Findings

I have ongoing problems with left gluteal and leg pain (burning, stabbing) at times severe, and sensory disturbances (decreased sensation in certain areas) also in the left leg. This is following a laminectomy/diskectomy at L5/S1 to correct a disc rupture with free fragment in October 1996. My surgeon said that at the time of surgery, he discovered a ganglion in my spinal canal (most are outside the canal, he says) that was directly compressed by the disc material that had ruptured. After the surgery, I improved, but began to get worse again about 2 months after surgery. An EMG in December showed that the gastroc area had improved, but that there was more irritability in the paraspinal muscles. An MRI in February 1997 showed scar tissue, mild in extent, surrounding the S1 nerve root. A new EMG in November 1997 showed no electrodiagnostic evidence of ongoing nerve damage, but did show electrodiagnostic evidence of old S1 radiculopathy on the left, according to the doctor's report. My question: I continue to have the server burning, stabbing pain in my left leg. Is the November EMG study saying that this is or is not being caused by a radiculopathy? Any other light you might be able to shed on my ongoing problem? Thanks very much for the service you are providing.

Answer :

Regarding the November EMG report. It is not uncommon to find such findings in patients following surgery. This EMG is probably reassuring. The point to remember, that EMG is very sensitive test, it can show mild changes (acute or chronic). It did help in your case to say that you had old lesion, the radiculopathy (or related to previous surgery) but no new significant nerve lesion despite some symptoms. I think some physiotherapy would help in your case. However, you had the last EMG in 97. So, if your symptoms are worse, then it is time to consult your doctor, repeat the EMG and even MRI.

Comment :

Thank you for your response. I want to make sure that I correctly understand your answer. Is the November EMG study saying that I still have a radiculopathy (even though there is no new significant nerve lesion)?

Answer :

Yes, but a chronic (or old) one. As said in the "EMG in November 1997 showed no electrodiagnostic evidence of ongoing nerve damage, but did show electrodiagnostic evidence of old S1 radiculopathy on the left". From EMG point of view, generally, it is fair to say in radiculopathy that EMG findings could indicate whether the abnormalities are due to acute (=new=fresh) or chronic (=old) lesion.

Comment :

Hi again,. Thanks for responding again. I understand and will follow up with my doctor. I really appreciate your time and the service you're providing.

Can bone gap in old nonunion fracture cause nerve damage?

Broke my tibia in 3 places. I had surgery to set the bone and implant a titanium rod and screws. I have 2 non-unions (bones aren't healing) so I have to have another surgery. I can't even be seen for several more months. In the meantime I've been walking on the broken leg with no assistance for the last 2 months. My accident was in July of last year. There is a sizeable gap in between the bones but the titanium rod gives me the support I need to enable me to walk. Here's my question, is there anyway that my nerves, tendons, muscle, veins, can get caught in between the bones and by continuing to walk I will pinch or sever something vital? I don't have another appointment with doctor until July. Would like some feedback before then. Thanks in advance.

Answer :

Even if there is a gap between bones (I assume seen in X ray) but that gap is filled with soft tissues and you have the rod fixed. The point that if fracture fresh it may injure nerves, vessels, etc. Therefore, I do not expect that to happen in your case at this stage.

Leg is worse after EMG test done for hypokalemic periodic paralysis

My 14-year-old daughter was hospitalized a month ago after experiencing paralysis in her arms and legs. A pediatric neurologist determined that she suffered from a condition known as hypokalemic periodic paralysis. An EMG was performed the first night in the hospital, which confirmed the doctor's suspicions. An MRI, EEG, EKG and a pulmonary function test were also done to rule out anything else. Her arm function came back by the end of the first evening in the hospital. However, her legs came back a little slower. Her right leg came back suddenly three days later, however her left leg did not come back for another three days but the function came back floppy weak and painful to walk on. The neurologist scheduled another EMG five days later to again test her muscle function. Although the first test was three hours long and quite uncomfortable for my daughter, she was able to endure the pain. However, the second test was so agonizing with excruciating pain that my daughter was unable to complete the test. She only lasted about 30 minutes until it was so unbearable she could not breathe. After that second test, her left leg was worse with extreme pain. It has been almost a month now and it has not gotten any better and she is unable to bear her weight on it without pain. Could the doctor have damaged her sciatic nerve? The pain is from her hip all the way down her leg. She is on Diamox and Potassium to treat the hypokalemia. The other symptoms she had been having prior to being diagnosed with hypokalemia have disappeared (body pain and fatigue, insomnia, headaches and muscle and bladder spasms) except for this leg problem. She is receiving physical therapy twice a week and the therapist is as baffled as we are to why is not getting better. Please advise.

Answer :

Nerve conduction studies and EMG are useful to diagnose hypokalemic periodic paralysis during the attack. This should reverse back to normal between the attacks. But, I am not aware of any case got sciatic nerve injury during such procedure. Please consult a neurologist to verify the problem.

Can EMG localize if injury level if it is in the spinal cord or not?

Can EMG show if a nerve injury is from the spinal cord? I took a fall at home in January. Hurt my neck up high. Slowly, I got weakness in arms with uncoordination, then in the legs, with fasciculations, weakness and heaviness. I was told after EMG that I had nerve damage in arms and legs, particularly in left hand? Can EMG tell exactly where the nerve damage comes from? Since MRI showed bulging at c34, c45, c56 - and hernia at L4-5, it is assumed that my symptoms are related to the disks. However, I just need to know how sensitive the EMG is and what can it actually rule out?

Answer :

There are 2 kinds of nervous system; central nervous system (CNS) and peripheral nervous system (PNS). The CNS consists of brain and spinal cord. EMG has no role in diseases or lesions of CNS. But EMG has important role in diseases of PNS, starting from motor neuron at spinal cord down to roots, spinal nerves, plexuses, peripheral nerves, neuromuscular junction and muscles. In spinal cord lesion, if there is associated root (nerve) lesion or damage, then EMG is useful to localize the involved nerve or "level". However, only at C5 and below. Higher level, EMG does not help.

Comment :

What symptoms would c34 and c45 bulging cause if these are two areas that could not be detectable on EMG?

Answer :

Level C3-4 (C3 root is intact): muscles are flaccid then spastic (after spinal shock). Breathing is affected (patient cannot breathe on his own). Loss of sensation below the neck. Reflexes are brisk (absent initially with spinal shock).
Level C4-5 (C4 root is still intact): Muscles are paralyzed as above. But patient can breathe on his own but low reserve. Sensations are preserved to upper chest but still not in upper limbs. Reflexes changes as above.

I think I need to explain how the C3 root intact at Level C3-4. This can be explained because of anatomy of the roots to vertebral column. At the cervical level, the root exit ABOVE its corresponding vertebra. That is, C3 root pass above the C3 vertebra. Therefore, in C3-4 level, the C3 root is intact and likewise the C4 root is intact at C4-5 level. This rule is only applied for cervical spine but not for thoracic or lumbosacral spine, as the root passes BELOW its corresponding vertebra.

Outer lower leg pain with normal studies

I have a pain in the middle of my lower leg that sometimes runs down to my ankle. Never above. I have no back or upper leg pain. It occurs when I walk around 1 or 2 miles or stand for a while. An awareness of the area also occurs when lying down. When sitting everything is fine. I am only in my 40's and have had vascular tests, MRI and an x-ray nothing on any of these tests was wrong. It was suggested perhaps it is nerve pain and I should go to for an EMG. I don't know what to do. Could this be nerve pain? The pain is not unbearable. But does make me not want to walk for a while any distance.

Answer :

The pain you describe does not sound like it would be "nerve pain". The work-up you have had, vascular and MRI is appropriate for the symptoms you describe.

Sometimes electrolyte imbalance may cause muscle symptoms such as cramps or fatigue, which usually cause vague symptoms of pain and ache in the muscles.

A good internist may focus more on the general aspect of your symptoms and maybe helpful in your case.

What does an absence of H Reflex mean?

I had an EMG after laminectomy, spinal cord stimulator, and spinal fusion I am having a lot of pain and a gripping pain in left leg and foot at times. The EMG shows increased polyphasics and increased amplitudes of the medial gastroc and peroneal. Interference pattern however was normal/ Impressions: Bilateral S1 radiculopathies chronic appearance. Values were all within normal limits. The only abnormalities found were absent bilateral H-reflexes. What does this mean? Sounds like I have no problems, but I hurt all of the time. And sometimes excruciating.

Answer :

Absent (or delayed) H-Reflexes are seen with S1 radiculopathies and are an indication that the sensory and/or motor arcs of the reflex pathway are damaged. So these findings on the Nerve Conductions are compatible with the symptoms you describe and do not indicate any other problem besides what you already know you have.

As for the pain, this question is best addressed by your treating doctor who seems to be quite familiar with your case having performed all these procedures and would be in a better position to answer the question.

Doctors say I have spinal cord sprain and I cannot understand that term.

I had an EMG, which showed radiculopathy in c spine and Lumbar spine. I have been getting weakness in arms and legs, tingling and small muscle jumps. Doctors did MRI of neck and found bulges. After symptoms progressed, Doctor said I might have spinal cord sprain. I'm trying to look it up and I can't find any such thing on the internet. He said his physical exam indicated this. IE: hyper tendon reflex. Ever hear of this. Is this a cervical spine sprain? or something different?

Answer :

Well I suspect he may have said spinal stenosis (? or spondylosis) causing the increase in your tendon reflexes and the radiculopathies.

Comment :

No, he did not specify stenosis, and it didn't appear on the MRI as a stenosis. And it seemed that the only leg that had hyper tendon reflex was my left leg. (Because I remember him noting that.) What do you make of this? Also, he seemed to get a lack of reflex at my left wrist. Is that a positive or negative sign?

Answer :

Spinal cord sprain is not a diagnosis or a clinical condition. Probably a description of something different that your doctor tried to put in layman's term.

Do not know what to make of your "hyperreflexia" on one side, this would be certainly the case when you have a stroke, but in problems originating from the back or the neck and involving roots, the case is hyporeflexia on the other side. The same is true for your left wrist.

Saphenous nerve injured during surgery

I had surgery on my left leg/calf muscles (chronic compartment syndrome) back in December. I'm a marathon runner. The surgeon cut the saphenous nerve middle way between my knee and ankle. A neuroma formed along with a fair amount of scar tissue. You can actually see a large bump that comprises the scar tissue/neuroma. I've been through 2 months of physical therapy with no luck. I can't feel the inside portion of my leg from the "bump" down to my ankle. It's dead numb. My problem is that I can't run at all without severe pain (millions of pins and needles) from the nerve stump hitting against the scar tissue - is kinda how it was explained to me. My orthopedist sent me to a neurologist. I saw the neuro. Yesterday, he suggested taking nuerontin 1 hour before I go out to run, but warned me that it could make me sleepy and dizzy - isn't that not a very good idea to go out and exercise after taking neurontin? Secondly, my Ortho. Surgeon is recommending as an alternative to go in and clean out the scar tissue to allow for maybe the nerve to regenerate. The neuro. is against surgery and feels I should try the drug route. I'm against taking any meds. Unless necessary. Any thoughts on my problem would be appreciated. Should I take the neurontin and risk running into a tree or go with surgery knowing there's no guarantee? Dazed and confused.

Answer :

Well, it's a tough call. But in cases such as yours, you have to consider the following:

1) The Neurontin may not make you sleepy, but also it may not significantly relieve your symptoms. Can't say until you try it.

2) Surgery may work, but in my opinion it's a 50-50 proposition. We're talking about hair size nerves which can actually give a lot of symptoms (which you have already experienced) and will be a challenge to fix at best. I suppose if it doesn't work you can say you had nothing to lose, and if it does, so much the better.

As I said it's tough call. Go with your guts and with the doctor you trust most.

I had a positive EMG in Nov 00. This due to multiple spinal problems. After my second spinal surgery (lumbar fusion with hardware, L3-4, L4-5, L5-S1) in April - I have had new nerve problems. Immediately following surgery - in Post-Op, I felt pain, burning, shocking, from left hip down outside of left thigh, across top of left thigh to around the knee. This burning has been persistent. There is also pain on touch - from the strangest of things, clothes, etc. If I bump my leg on something - the pain is unbearable. Also gooseflesh, nothing uniform - patches over left thigh? Skin feels rubbery' almost numb on touch - no sensitivity or feeling of cold. I had an EMG yesterday - the Tech said it was normal, both the muscles and nerves. What could be causing this? Is there a reason why this did not show up on my EMG? Would a CT scan be helpful? My surgeon said it was possibly superficial nerves? what is that - would that not show on an EMG - will it show on CT scan? Thank you for any info!

Comment :

This is true. This kind of cutaneous nerve damage is not actually seen or examined in the "routine" nerve conduction studies. Even EMG does not show anything. CT scan does not help either. This is clinical diagnosis depends practically on the patient's symptoms and signs on examination. However, we may study such nerve specifically (not done routinely in many laboratories), and then usually its results are compared to other side. The problem it is not always easy to record even in normal persons. Although, its management is usually conservative but surgery may be offered, it is up to the treating doctor.

Charcot Marie Tooth (CMT) deferential diagnoses

My daughter and I have been through many tests. We have all the hallmarks of Charcot Marie Tooth type 2. Foot deformity, lower leg wasting (post surgical for both of us, before that they were hypertrophic) I have symptoms of carpel tunnel and numbness in both my hands and feet at a constant level. Pain in our legs and we both use AFO's to hold up the lower leg and help control the pain...etc...NCV was normal, EMG showed slight problems. During my last foot correction they did a surel (SP?) nerve biopsy and it was normal. My neuro thought we were looking at CMT type 2 until the biopsy came back...now she is puzzled. She is sending me to another specialist in Boston to dig deeper... At this point the list we have makes us a difficult case to diagnose. My neuro says its a peripheral neuropathy. But which one? Any insight you may have will be appreciated. We are a test case and at this point I want to just figure it out. Mine was later onset (17 or so) and my daughter was from birth (she is 8 now) it is very slow progression. thanks again..

Answer :

I do not think I am in better position. You really need to be seen by good neurologist to look into your case in details. Please keep us updated.

Comment 1 :

Thanks....I will let you know how we make out.

Comment 2 :

Can I ask....is it possible to have a normal nerve biopsy and still have CMT?? Thanks

Answer :

The nerve biopsy would show characteristically abnormal nerve fibers, however, some normal fibers may be seen. However, I do not have numbers for % of normal results (not even from the little search from textbooks or pathology department in our area). However, this is outside my specialty.

Comment 1 :

Thanks for you response.....All my DNA sequencing tests came back normal for CMT and hnpp....which was expected. There is no test for CMT type 2 yet (this summer)
My neuro said this week that it is possible but unlikely to have a normal nerve biopsy and have CMT type 2,although there are cases all the time that bend the rules....."the disorders don't read the books" she said.
Good news regarding the specialist in Boston...I have an appointment June 15th.....I didn't expect one so soon...I will keep you posted. Thanks....

Comment 2 :

we went to the neuro specialist in Boston today. He was very thorough and he spent an hour with us. He agreed that the test results are vague at best and only rule out an obvious case of CMT type 1. When you have the same hallmarks but results are mixed or normal you have to consider a neuropathy in muscle or skeletal as well. They will present with the same symptoms.
He also said that there are actually 17 types of CMT now and there only exists DNA testing for three of them. Most often the diagnoses is made clinically and not through testing and that often DNA testing is positive in only 4% of cases. It kind of put things in perspective for me.
I wrote down all the symptoms and surgeries both my daughter and I have had. He made copies and will look everything over and give me a call next week. He may order a more refined nerve study and/or an actual nerve fiber count from the sural nerve biopsy. He is also going to send for the actual biopsy tissue to have a look.
He seemed to think it was some type of CMT and I told him I was only interested in finding a name for this for my daughter's sake. we don't look at any of this as if it is "the end of the world" and both my daughter and I see the glass as half full. It would be helpful to know what it is for the purpose of acceptance. Just knowing what it is will make it easier to cope with..... And also so I don't spend any more time going to all these different doctors for things that are just "part of the disorder"..... Because of this he seemed very interested in helping us dig deeper. I will let you know when I hear from him...thanks!!

Answer :

Thank you. I am following your emails with great interest. All the best.

Comment :

The specialist wants to do another EMG...this will be number three....I will let you know how I make out....thanks

Recovery of Peroneal Nerve injury

Hello. I suffered a Compartment Syndrome of the right leg on April 1st of 2001. It's been 2 months and I still have drop foot and paresthesias on the top of my foot. My orthopedic Doctor says that 3-6 months are my best chances at recovery of the nerve. Should I be concerned that I haven't seen more improvement in 2 months? Can recovery take MORE than 6 months?? What can I do to IMPROVE my chances of nerve regeneration...anything? My doctor says most people recover 60% to 70% of their "Normal" function once the nerve comes back. Are there "Exceptions to the rule"? P.S. I'm 28 years old and WAS very active athletically. I've been told that improves my chances. Is this true? Sorry about so many questions but my Dr. is ALWAYS out of town (Cle. Indians Dr.)!! I get my EMG results next week. Thank you and GOD BLESS this SITE!!

Answer :

The recovery of the peroneal nerve injury following the compartment syndrome depends on the time of release surgery and on EMG studies. It may take more than 6 month, but I would not be certain without having EMG studies beforehand. I would recommend intensive physiotherapy; this should be very helpful to "prime" the muscles for the reinnervation when it happens. Also, you should quit smoking and alcohol (if any), because they would delay the process of nerve regeneration.

Does "No Response" mean "No Regeneration"?

I posted here recently about my peroneal nerve damage from a Compartment Syndrome. My EMG results showed No Response from my Peroneal Nerve function. It has been 2 months from the injury. Does this mean that my nerve IS NOT re-generating? My Ortho and the Neuro think I need a nerve graft and have referred me to a specialist. Should I hold out hope of the nerve healing, or does the EMG result mean the nerve isn't coming back?

Answer :

I posted here recently about my peroneal nerve damage from a Compartment Syndrome.

My EMG results showed No Response from my Peroneal Nerve function.

It has been 2 months from the injury. Does this mean that my nerve IS NOT re-generating? My Ortho and the Neuro think I need a nerve graft and have referred me to a specialist.

Should I hold out hope of the nerve healing, or does the EMG result mean the nerve isn't coming back?

Commentfrom anotherpatient :

What a coincidence...I damaged my radial nerve on April 1, 2001 - the same day as you (see posting from May 25). I have wrist drop which has not improved and the sensory function seems to be slowly coming back. My ortho was also hopeful that it would recover on its own but the EMG tests that I had two weeks ago showed fibrillations at rest (indicating denervation) and no motor unit potentials (no response). I'll be having surgery this week. Realistically, if surgery needs to be done, sooner is better since the neuro-muscular junction degrades over time. If the EMG tests showed no reason to hold out (although it still is a judgment call), then don't delay. I believe that two months can still be considered somewhat early. I know that recovery probabilities after surgery vary depending on age, elapsed time, severity of the injury and mode of repair (re-connecting vs. graft). I also know that recovery time is very very slow - 1 inch per month, but I'm less concerned about that than about the percentage recovery at the end. But, there isn't much I can do besides hope. I'm 25 and am otherwise healthy and (was) very active, so I'm hoping for the best. Best of luck to you too.

Answer :

2 months are not too late. Also, you should hold out hope. In a humble way, the EMG does not mean the nerve isn't coming back at this stage of your lesion; it is used as a guide to the doctor, what is the next step should be.

Comment :

o then, what do YOU (your opinion) think my next step should be?

I find out tomorrow what Dr. Anderson, (who is supposedly the best Nerve doctor in the Cleveland area at nerve grafting) thinks about my case.

As far as I can see, my only two options are to:
1. Have the nerve graft A.S.A.P and hope for the best.

2. Wait a couple of months and see if there's any further Re-generation.
What do YOU think I should do?

P.S. I KNOW there was at least SOME Re-generation because I had NO feeling of the CPN on the outside of my knee for the first 3 weeks after surgery but now can feel "Tinel's sign" when I tap on the outside of my knee.

Answer :

That is what I had in mind, same 2 options. But it is up to the treating doctor to decide between them.

Comment :

Well, a MIRACLE happened on Tues. night!!

Right before going to bed, I told myself to TRY to lift my foot since I hadn't at least tried yet that day and to my surprise....IT ACTUALLY WORKED!!

This was probably the happiest moment of my life besides my Wedding day (just in case my wife reads this)!

So I saw Dr. Anderson and he said my MRI shows no neuroma and he thinks that with my dorsiflexion coming back (Even though it's only about 1 inch) that we will just wait and see how much it heals on it's own!

This is the BEST CASE SCENARIO!!

I feel SO BLESSED after today!

I know that GOD is healing me!

Thank you VERY MUCH for your information!
It was VERY HELPFUL!

I was pretty "Down" after my EMG results, but you told me to NOT give up, and it lifted my spirits. For that, I thank you again. It's amazing what a person can do to with a keyboard.

Answer :

Thank you very much indeed. I am delighted. It is my feeling when a patient gets better and all thanks go to God. Also you are right always remember your wedding day just in case. All the best.

Chronic lumbosacral/pelvic/left hip pain. Surely someone has a clue!

Ok, this seems like an intelligent forum. I am looking for a fabulous problem-solving expert, because I just know my condition cannot be impossible to figure out and treat. Bear with me while I describe: traumatic childbirth in 1990, suffered 4th degree tear and (undiagnosed) damage to sacrum. Developed intense left hip pain, followed by a subsequent 'irritation' on left side of pelvic floor. This pain is the teeth-clenching kind, variably raw, sore, like a 'toothache' pain or a 'pinching' feeling or the grandest wedgie you ever experienced. Apparently it is unusual to have tenderness only on left side of pelvic floor, but that's what I have. Pain on left side of sacrum and in all left hip/buttocks muscles, with sensation radiating down left leg into foot and up left arm into shoulder. Aggravated by everything, but particularly by anything where I sit and have arms extended, like playing the piano or sitting at a computer. Went to Mayo where they assured me I was not nuts and got me on the pelvic floor myalgia path. Have been in pt ever since where they finally diagnosed and actually have stabilized my hypermobile sacrum. They are beginning myofascial work for the pain and in one treatment actually made the horrible pelvic pain disappear for a few days. My questions are: has anyone ever heard of something like this? Is there someplace I should/could go to expedite the situation? Would nerve blocks be possible -- is there anyplace that can be directly injected here? I tried the spinal injections with inconclusive results. I would love any info/input that could lead to me getting my life back. Thanks for any help you can give.

Answer :

FI believe you are at the proper hands. Because it is long standing problem, it would rather take longer time to get better, and what is reassuring that the treatment works. Carry on the PT. I wish you all the best.

Femoral neuropathy with no effect of medical treatment

I have had chronic and often debilitating pain in my right groin area and left lower back for several years. Recently I was diagnosed as having femoral neuropathy. The doctor started me on injections (useless) and amitriptiline and carbatrol. The drugs cause me to hallucinate and be so confused it's hard for me to work. I am just about at my wit's end. Has anyone else had this problem? Often, the pain is so bad I can't move. The only relief I have found is to lie very still and freeze the areas with ice. Does anyone have any suggestions?

Answer :

I wondor, whether the "femoral neuropathy" is to be blamed for all of your symptoms. I would recommend consulting neurologist, if you have not seen one yet. Also, are you diabetic? I am referring to diabetic lumbosacral radiculoplexus neuropathy (diabetic amyotrophy). However, basically similar condition does also occur in non-diabetic; called "non-diabetic lumbosacral radiculoplexus neuropathy".

Tingling hand and feet with weak legs

I am a 44-year-old male, 140 lbs, 5'6". For the past few years, I have experienced weird symptoms. My hands and feet intermittently tingle and hurt, my arms feel like they are sunburned, I get random pin-prick sensations about anywhere on my body. My legs are weak as I find myself standing with my knees locked. My vision is almost foggy, for lack a a description and images with repeating patterns "shimmer". My memory has been real poor and I tend to flip words around in sentences. Sometimes when I wake in the morning, I can't tell where my arms are. I have seen a Neurologist in 1998 and had an MRI and some reflex tests. Came back fine. He said, "not to worry". I am very worried.

Answer :

According to your description (not all symptoms though), peripheral neuropathy should be ruled out. You had MRI and have seen neurologist in 98, MS was out, I guess. Anyway, EMG is needed in your case and I would recommend seeing a neurologist again. Please keep us updated.

Commentfrom anotherpatient :

I'm not a physician but have similar symptoms.
Have them evaluate you for a small fiber sensory neuropathy.
(Some helpful diagnosis tests for this are the quantitative sensory testing and the small fiber skin punch biopsy) EMG and Nerve conduction studies and routine Neuro exams will not diagnose this. Also when you mentioned shimmering in the eyes thought this site would be useful. www.geocities.com/quinolones/
Many on this site have experienced long term (as in years) visual problems, paresthesias, and sensory disturbances, memory and brainfog muscle weakness etc.
I assume your Neuro has done differential diagnosis ruling out things like: Lyme Disease, MS, Lupus, Hepatitis, Autoimmune diseases, B12 deficiency, vasculitis, diabetis, viral and infectious etiologies like Histoplasmosis, Toxoplasmosis, paraneoplastic syndrome, Cytomeglovirus, ME, etc.
Often times Physicians assume someone just has a post viral syndrome and labels the cases idiopathic and does no further testing. However treatable things should be ruled out first.
Some useful sites may be
Massachusetts General Hospital Neurology Forums
Cleveland Clinic Neurology Forums
Neuropathy Trust website
Neuropathy Association website
and www.geocities.com/quinolones/

Spinal Stenosis

Hi. I'm new, so please bear with me. I recently had an MRI & x-rays that showed the following: Congenital narrowing of the AP dimension of the cervical spinal canal measuring 12mm or less at all levels from C2-T1; decreased T2 signal in the disc spaces at all levels throughout the cervical spine consistent with disc dissociation and DDD. Moderate narrowing at the C5-6 & C6-7 disc spaces w/diffuse chronic disc bulging & osteophyte formation at both these levels. Resultant mild C5-6 & moderate C6-7 focal spinal stenosis as well as bilateral bony neural formainal stenosis at these levels, moderate in degree, and left bony neural foraminal narrowing at C4-5. No significant abnormal signal is seen within the visualized posterior fossa structures or spinal cord. Slight edema within the left side of the C6 vertebral body. Degenerative Osteoarthritis, reversal of the normal cervical lordosis due to muscle spasm or positioning; spurring; prominent degenerative sclerosis & spurring in right C3-4 & left C4-5 facet joints; slight degenerative anterolisthesis at all disc spaces from C2-C5; mild retrolisthesis of C5-6. I have had severe neck pain, mostly on left side, with numbness & tingling in my feet, arms, hands, legs; elbow pain; can't sleep good; I am on Vioxx, skelaxin, just finished a course of prednisone and seeing a phys. therapist 3x weekly. The numbness is getting better and pain not as bad, but always there, so is tingling. My question is: Am I a candidate for surgery??? I do see a neurosurgeon next week, but am just wandering what your opinion is?? Thanks...Sueb57

Answer :

The decision of surgery is determined by neurosurgeon. However, generally the severity of pain, presence of signs (cord compression) is among the important factors to consider. As well as the prominent correlated radiological findings. All the best. Please keep us updated.

Abnormal NCV in different situations

Can an NCV be abnormal and an EMG be abnormal? What does an abnormal NCV (peroneal) mean? Can repetitive ankle sprains cause abnormal NCV?

Answer :

1. Yes they can.
2. It would mean the nerve is affected or diseased. In case of peroneal nerve usually means affection at the level of the knee joint (at head of fibula). Sometimes, atrophy of the small muscle on the dorsum of the foot (Extensor digitorum brevis) would cause abnormal peroneal nerve study, although the nerve is fine "proximally".
3. Yes, I have seen it. Although, the changes are "mild" involve the EMG (needle electrode examination) rather than the NCV (nerve conduction studies).

Numbness is getting worse and spread to whole Lt. Side; now I'm scared

Since my last post from just last night, the numbness has spread. I'm now numb all the way down my left side, though not as severely as in my hand. From the shoulder down, down the left rib cage, all the way to my ankle (but only on the outside of both the arm and the leg.) I tried today to get an appointment with several area neurologists, and can't get one until mid-August! My family doctor will see me day after tomorrow, but I'm not sure what he can do, other than sympathize. At this point, I think I'd rather know what it is not, than to get rid of the symptoms. I'll deal with the symptoms later. But my imagination is going nuts, with thoughts of everything from MS to diabetes to stroke to heart attack. Again, I have no pain and no loss of strength (thank God.) But my fear alone is weakening me. Please help me drag myself out of this panic.

Answer :

Seek help, use the fear to find the advice about your problem, but do not let the fear control your mind please. It would be better to go to an emergency department in hospital or as you said see the family doctor, to be reassured, until your appointment with the neurologist.

Commentfrom anotherpatient :

Your family doctor might be able to get you in to see a neurologist sooner. The exact same thing happened to me- he got me in to see the neurologist the next day. Mine turned out to be nothing and eventually subsided (it has not completely gone away, but almost). The family doctor can test for diabetes. The neurologist tested for lupus and MS- they never did figure it out (that's a little unsettling but at least I am better). Apparently sometimes it can be some sort of a weird virus. I went for a second opinion and he thinks it maybe a very mild case of Guilliam Barre.

Answer :

Thanks. Even typing this is such a consummate pain (not literally) in my rear. Just wanted to say that I saw the doc today, and he has ordered blood tests, nerve conductions/EMGs Monday at the neurologist, and a carotid study at the hospital in two weeks. (Can't get a consult with the neurologist, but he'll do the tests, read them, and send their findings to my family doctor--go figure.) I hope mine disappears as well, but for now it's just getting more severe. He did rule out heart involvement and diabetes and says he suspects peripheral rather than central nervous system problems. This thing is screwing around with my mind now, and I'm fighting very hard to fight the fear of the unknown. I'll let you know...

How accurate are the test results for spreading numbness in hand and feet?

I had Nerve conduction and EMG tests done last fall as a result of spreading numbness in my hands and feet. The results showed that I had "mild, symmetric, axonal, predominately motor polyneuropathy with loss of fast conduction fibers." The condition began to improve on its own, so the doctor said not to worry about it. (They do not know what could have caused it.) Because I still have intermittent, mild numbness I went for a second opinion (using the same test results). The second doctor said that the test is very subjective and that I may not, in fact, have nerve damage. How subjective are the test results? Should I be concerned if the tests reflect that I have mild nerve damage?

Answer :

This is quite interesting question. Although, nerve conductions and EMG are "objective" tests. But certain factors must be well controlled such as temperature and distance measurement. As well as stimulus setup. Those are in a way "subjective". Anyway, the examiner is usually fully aware of those factors and they are standardized. If the abnormalities are really mild, they may be considered as insignificant. What matters is that you are clinically feeling better.

Femoral nerve damage after an abdominal-pelvic floor surgery

Two weeks ago, my wife underwent an open abdominal pelvic floor repair operation for cystocele and rectocele . She has lost the feeling totally in her left knee and inner thigh and has tenderness to the touch in her left groin. She is unable to stand or of course walk and has been advised that her femoral nerve is damaged. Can you tell us if this is a common occurrence and if the damage will repair and when? Thank you. Very concerned.

Answer :

Femoral nerve injury may occur after pelvic floor operations. Not a common occurrence. The recovery is usual, but it depends on the severity of the lesion and being an isolated or part of lumbosacral plexus lesion. We should wait for EMG study to tell us all that. I wonder; did neurologist see her?

Comment :

Thank you for your help doctor. My wife was seen by a neurosurgeon. He informed her that in the worst scenario, this damage could possibly take up to 2 years to repair. She has undergone EMG tests today. Can you tell us if these tests will give information on the repair time for the damage? Thank you.

Numbness and burning sensation in case of touching leg or buttock

Last week I took a tumble on a flight of stairs at work. The hospital took various x-rays and informed that nothing was broken but the doctor has put me on flexeril 10mg. 3x day, lortab 5.5 every 4 hrs. The doctor has me off of work for at least another 2 weeks. I have numbness and a severe burning sensation if I touch my leg or my buttocks, and my right leg and foot goes to sleep if I sit or stand for any length of time. I have started having severe headaches, and SHARP shooting pains. Is this something I should worry about?

Answer :

This kind of injury is quite common. I can understand the "numbness and a severe burning sensation" in the leg and buttocks. However, I advised you to see neurologist because of the headache and Sharp shooting pains. You may have another injury. Did you lose your consciousness or do you have vomiting?, if so then you need to see neurologist soon.

Comment :

I didn't lose consciousness and I haven't actually vomited, just constantly nauseated, nothing tastes good and really don't have an appetite unless it's for something sweet, which is unusual since I don't normally eat sweats. Today, whether I'm trying to stand propped up against the sink to do dishes or just lie on the couch or in bed, I'll have pains so extreme that they literally make me jump. I'm not sleeping well, and when I try to get up the pain is indescribable. The pain seems to be radiating up my back and into the hip area, where before there was just a nagging. I haven't seen a neurologist yet, only an orthopedist. I go back next Thursday for a follow up, if I survive that long. I was injured at work and usually workman comp. Cases are viewed as just a way for people to get out of working and still collect a check, so I don't want to seem neurotic. I'm not a person who can just lay about and do nothing and am about to go nuts. Is this a normal type of reaction? (The Pains) Any info would be appreciated.

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